Provider Demographics
NPI:1215713664
Name:TINNEY, MIKAYLA BAH
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:BAH
Last Name:TINNEY
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 1:3150 CARLISLE BLVD NE STE 110
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1681
Mailing Address - Country:US
Mailing Address - Phone:505-652-2022
Mailing Address - Fax:
Practice Address - Street 1:3150 CARLISLE BLVD NE STE 110
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1681
Practice Address - Country:US
Practice Address - Phone:505-633-8173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program