Provider Demographics
NPI:1942203872
Name:GOINS-HARMON, TANYA S (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:S
Last Name:GOINS-HARMON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:TANYA
Other - Middle Name:S
Other - Last Name:HARMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:318 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-2337
Mailing Address - Country:US
Mailing Address - Phone:270-251-3223
Mailing Address - Fax:270-251-3220
Practice Address - Street 1:318 S 7TH ST
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2337
Practice Address - Country:US
Practice Address - Phone:270-251-3223
Practice Address - Fax:270-251-3220
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002813363L00000X, 363LF0000X, 363LF0000X
KY3002813 GRP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY597243OtherWELLCARE
KY363LF0000XOtherTAXONOMY CODE
KY78028131Medicaid
KY3002813OtherNEW LIC # 01-10-11
KY000000612626OtherANTHEM
KY363L00000XOtherTAXONOMY CODE
KY7100090880OtherMEDICAID ARNP GRP
KY7100090880OtherMEDICAID ARNP GRP
KY00975002Medicare PIN