Provider Demographics
NPI:1326024894
Name:AUSTIN-KETCH, TAMMY LEIGH (NP)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:LEIGH
Last Name:AUSTIN-KETCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3596 CURTISS AVE
Mailing Address - Street 2:PO BOX 59
Mailing Address - City:RANSOMVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14131-0059
Mailing Address - Country:US
Mailing Address - Phone:716-870-4668
Mailing Address - Fax:716-829-2067
Practice Address - Street 1:3003 9TH ST
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14305-1931
Practice Address - Country:US
Practice Address - Phone:716-284-8917
Practice Address - Fax:716-284-0428
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF331418363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000560260001OtherBCBS
NY000560260001OtherCB
NY00026506601OtherUNIVERA
NY9511835OtherIHA
NY01710838Medicaid
NY000560260001OtherBCBS
NY9511835OtherIHA