Provider Demographics
NPI:1134505647
Name:PLEMONS, TAMMY WYNETTE
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:WYNETTE
Last Name:PLEMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TAMMY
Other - Middle Name:WYNETTE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGNP-C
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:803-435-5270
Mailing Address - Fax:803-433-0154
Practice Address - Street 1:10 E HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-3153
Practice Address - Country:US
Practice Address - Phone:803-433-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19641363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology