Individual
SANDRA J TINNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3202 MCINTOSH CIRCLE, SUITE 101, JOPLIN, MO 64804
(417) 781-9200
(417) 781-9471
Mailing address
PO BOX 5037, JOPLIN, MO 64803-5037
(417) 781-9200
(417) 781-9471
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
096202
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100052950A
—
OK
05
—
100299510A
—
KS
01
—
132296
ANTHEM
MO
05
—
428931307
—
MO
01
—
500008264
RR MEDICARE
—
Enumeration date
06/25/2006
Last updated
07/20/2010
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