Provider Demographics
NPI:1134668346
Name:KENNEDY, TAMMIE (RN BSN)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201-2536
Mailing Address - Country:US
Mailing Address - Phone:307-631-8836
Mailing Address - Fax:
Practice Address - Street 1:1550 CEDAR ST
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-2536
Practice Address - Country:US
Practice Address - Phone:307-631-8836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY29545163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse