Provider Demographics
NPI:1770871329
Name:MCKINNEY, TIFFANY RENEE (AUD)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:RENEE
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:RENEE
Other - Last Name:ARMSTRONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10700 N RODNEY PARHAM RD STE A7
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-4159
Mailing Address - Country:US
Mailing Address - Phone:501-225-6060
Mailing Address - Fax:501-225-6450
Practice Address - Street 1:912 WALNUT HILL DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5052
Practice Address - Country:US
Practice Address - Phone:903-291-6300
Practice Address - Fax:903-291-6305
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1116A231H00000X, 237600000X
TX80421231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR237677720Medicaid