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Individual

MISS TIFFANY SHANNON RAY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
6410 WALNUT GROVE RD, HORN LAKE, MS 38637-2023
(901) 652-0880
Mailing address
PO BOX 381468, GERMANTOWN, TN 38183-1468

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
15099
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
864509
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200020616
MS
05
Q057613
TN
Enumeration date
11/09/2006
Last updated
02/16/2026
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