Provider Demographics
NPI:1275552622
Name:EARHART, TAMMY M (PA-C)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:M
Last Name:EARHART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3322
Mailing Address - Country:US
Mailing Address - Phone:540-667-8975
Mailing Address - Fax:540-667-6589
Practice Address - Street 1:128 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3322
Practice Address - Country:US
Practice Address - Phone:540-667-8975
Practice Address - Fax:540-667-6589
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002269363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010273820Medicaid
VA010273820Medicaid
VA010653W82Medicare PIN