Provider Demographics
NPI:1326272493
Name:WHITEHEAD, TAMMY L (ARNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 WACO DR
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-8327
Mailing Address - Country:US
Mailing Address - Phone:606-770-5161
Mailing Address - Fax:606-770-5168
Practice Address - Street 1:43 WACO DR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-8327
Practice Address - Country:US
Practice Address - Phone:606-770-5161
Practice Address - Fax:606-770-5168
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006097363LP0808X
KY6097P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000657974OtherBCBS