Provider Demographics
NPI:1740439579
Name:MCKINNEY, TAMMY KAY (ECDT)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:KAY
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:ECDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2936 BATEMAN RD
Mailing Address - Street 2:
Mailing Address - City:OKOLONA
Mailing Address - State:AR
Mailing Address - Zip Code:71962-9624
Mailing Address - Country:US
Mailing Address - Phone:870-403-7606
Mailing Address - Fax:
Practice Address - Street 1:2410 PINE ST
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-4335
Practice Address - Country:US
Practice Address - Phone:870-245-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator