Provider Demographics
NPI:1083618318
Name:DUNN, TAMMY LEA (AUD)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:LEA
Last Name:DUNN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S UNIVERSITY AVE
Mailing Address - Street 2:STE A13
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5344
Mailing Address - Country:US
Mailing Address - Phone:501-664-0337
Mailing Address - Fax:501-664-8191
Practice Address - Street 1:500 S UNIVERSITY AVE
Practice Address - Street 2:STE 606
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5342
Practice Address - Country:US
Practice Address - Phone:501-664-0337
Practice Address - Fax:501-664-8191
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA106174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131463720Medicaid
AR5T556OtherBCBC/MEDICARE PROVIDER #