Provider Demographics
NPI:1487845624
Name:RANSOM, TAMMY BURDEN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:BURDEN
Last Name:RANSOM
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-450-7419
Mailing Address - Fax:812-450-6760
Practice Address - Street 1:310 W IOWA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1724
Practice Address - Country:US
Practice Address - Phone:812-450-7419
Practice Address - Fax:812-450-6760
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002452A363L00000X
IN28134404A363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200873860Medicaid
IN534980BBBBMedicare PIN
IN257900098Medicare PIN