Provider Demographics
NPI:1700692977
Name:CORNER, TAMMY ELAINE (RBA)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:ELAINE
Last Name:CORNER
Suffix:
Gender:F
Credentials:RBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 EDWARD DR
Mailing Address - Street 2:
Mailing Address - City:DANIELS
Mailing Address - State:WV
Mailing Address - Zip Code:25832-6500
Mailing Address - Country:US
Mailing Address - Phone:304-573-0163
Mailing Address - Fax:
Practice Address - Street 1:651 EDWARD DR
Practice Address - Street 2:
Practice Address - City:DANIELS
Practice Address - State:WV
Practice Address - Zip Code:25832-6500
Practice Address - Country:US
Practice Address - Phone:304-573-0163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV171M00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator