Provider Demographics
NPI:1518950633
Name:CLINE, TAMMY L (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:CLINE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:L
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:104 ALEX LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2952
Mailing Address - Country:US
Mailing Address - Phone:304-734-2040
Mailing Address - Fax:304-734-2047
Practice Address - Street 1:108 LEE ST E RM 129
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1506
Practice Address - Country:US
Practice Address - Phone:681-205-2455
Practice Address - Fax:681-265-3845
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27942363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000607Medicaid
WV2029503Medicare UPIN
WV3810000607Medicaid