Dedria Kay Tanton, LBSW
Individual provider Active NPI Case Manager/Care Coordinator · Rye, TX
NPI 1336474071 · NPPES record last updated Oct 16, 2009
Key facts
- NPI
- 1336474071
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Case Manager/Care Coordinator 171M00000X
- License
- 41790 (TX)
- Practice address
- 140 CR 2683 -- Gun Street
Rye, TX 77369 - Phone
- (936) 274-4649
- Fax
- (936) 274-4649
- NPI assigned
- Oct 14, 2009
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | 41790 | TX | Yes |
| Case Management Agency | 251B00000X | 41790 | TX |
Addresses
Primary practice location
140 CR 2683 -- Gun Street
Rye, TX 77369
Mailing address
PO Box 126
Votaw, TX 77376-0126
Phone (936) 274-4649
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.