Provider Demographics
NPI:1194479782
Name:KAY, TIFFANY
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:KAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:LONG PINE
Mailing Address - State:NE
Mailing Address - Zip Code:69217-0217
Mailing Address - Country:US
Mailing Address - Phone:402-382-8611
Mailing Address - Fax:
Practice Address - Street 1:787 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:LONG PINE
Practice Address - State:NE
Practice Address - Zip Code:69217-5297
Practice Address - Country:US
Practice Address - Phone:402-760-1687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant