Provider Demographics
NPI:1235703240
Name:WILSON, TAMMY LYNN (AGACNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:WILSON
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4258 HIGHWAY 231 STE 5
Mailing Address - Street 2:
Mailing Address - City:LACEYS SPRING
Mailing Address - State:AL
Mailing Address - Zip Code:35754-6444
Mailing Address - Country:US
Mailing Address - Phone:256-498-6500
Mailing Address - Fax:256-970-2929
Practice Address - Street 1:4258 HIGHWAY 231 STE 5
Practice Address - Street 2:
Practice Address - City:LACEYS SPRING
Practice Address - State:AL
Practice Address - Zip Code:35754-6444
Practice Address - Country:US
Practice Address - Phone:256-498-6500
Practice Address - Fax:256-970-2929
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-127155363LA2100X, 207QA0505X
AL13227637363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care