Provider Demographics
NPI:1528592508
Name:RADFORD, TAMMY LEIGH (RN)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LEIGH
Last Name:RADFORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 N PICKENS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PINEY FLATS
Mailing Address - State:TN
Mailing Address - Zip Code:37686-4111
Mailing Address - Country:US
Mailing Address - Phone:423-963-5110
Mailing Address - Fax:
Practice Address - Street 1:403 E G ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-3223
Practice Address - Country:US
Practice Address - Phone:423-543-2521
Practice Address - Fax:423-543-7348
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000207852163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health