Provider Demographics
NPI:1427204692
Name:MUSE, TAMARA JEAN (NP - CERTIFIED)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:JEAN
Last Name:MUSE
Suffix:
Gender:F
Credentials:NP - CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 SOUTH HWY 27
Mailing Address - Street 2:BLUE GRASS OAKWOOD
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-2935
Mailing Address - Country:US
Mailing Address - Phone:606-677-4068
Mailing Address - Fax:606-677-4147
Practice Address - Street 1:2441 SOUTH HWY 27
Practice Address - Street 2:BLUE GRASS OAKWOOD
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-2935
Practice Address - Country:US
Practice Address - Phone:606-677-4068
Practice Address - Fax:606-677-4147
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005646363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1427204692Medicaid