Provider Demographics
NPI:1447389648
Name:FLICKINGER, TAMERA LEE (STNA)
Entity Type:Individual
Prefix:MRS
First Name:TAMERA
Middle Name:LEE
Last Name:FLICKINGER
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 ORANGE RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-1722
Mailing Address - Country:US
Mailing Address - Phone:419-496-2692
Mailing Address - Fax:
Practice Address - Street 1:1101 ORANGE RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-1722
Practice Address - Country:US
Practice Address - Phone:419-496-2692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400198640103374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2586965Medicare PIN