Provider Demographics
NPI:1790225977
Name:CATES, TIFFANY LYNN (APRN)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:LYNN
Last Name:CATES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:LYNN
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2200 JEFFERSON AVE
Mailing Address - Street 2:5TH FLOOR MERCY PHO/CVO
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7101
Mailing Address - Country:US
Mailing Address - Phone:419-251-9830
Mailing Address - Fax:419-251-1826
Practice Address - Street 1:1532 LONE OAK RD
Practice Address - Street 2:STE 143
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003
Practice Address - Country:US
Practice Address - Phone:270-538-6600
Practice Address - Fax:270-538-6635
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100455170Medicaid
KYK228361OtherMEDICARE PTAN