Provider Demographics
NPI:1275778789
Name:MARTIN, TAMMY (BA, MHPP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BA, MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6704 WILBURN RD
Mailing Address - Street 2:
Mailing Address - City:WILBURN
Mailing Address - State:AR
Mailing Address - Zip Code:72179-9735
Mailing Address - Country:US
Mailing Address - Phone:501-454-4643
Mailing Address - Fax:
Practice Address - Street 1:1716 W SEARCY ST
Practice Address - Street 2:BOX 441
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-3532
Practice Address - Country:US
Practice Address - Phone:501-362-7595
Practice Address - Fax:501-362-6499
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator