Provider Demographics
NPI:1083236756
Name:PRESCOTT, TAMARA MICHELE (CPT)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:MICHELE
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-9606
Mailing Address - Country:US
Mailing Address - Phone:904-328-9788
Mailing Address - Fax:502-861-7287
Practice Address - Street 1:4611 N DIXIE HWY STE 100
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8828
Practice Address - Country:US
Practice Address - Phone:502-369-1654
Practice Address - Fax:502-861-7287
Is Sole Proprietor?:No
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor