Provider Demographics
NPI:1528667730
Name:COON, TINA
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:COON
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 1:1924 RIPLEY RD APT 1
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:WV
Mailing Address - Zip Code:25276-8763
Mailing Address - Country:US
Mailing Address - Phone:304-786-2145
Mailing Address - Fax:
Practice Address - Street 1:1924 RIPLEY RD APT 1
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:WV
Practice Address - Zip Code:25276-8763
Practice Address - Country:US
Practice Address - Phone:304-786-2145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant