Provider Demographics
NPI:1376711721
Name:TERRY, TAMMY S (NP)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:S
Last Name:TERRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:S
Other - Last Name:WARDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1785 W LEE HWY
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-1437
Mailing Address - Country:US
Mailing Address - Phone:276-228-6499
Mailing Address - Fax:276-228-6145
Practice Address - Street 1:1785 W LEE HWY
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1437
Practice Address - Country:US
Practice Address - Phone:276-228-6499
Practice Address - Fax:276-228-6145
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10998OtherMEDICARE GROUP PTAN
VA0024164736OtherSTATE LICENSE
VAC10998OtherMEDICARE GROUP PTAN
VA1376711721Medicare NSC