Provider Demographics
NPI:1558364620
Name:MONK, TAMMY (FNP)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:
Last Name:MONK
Suffix:
Gender:F
Credentials:FNP
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 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:423-857-2070
Practice Address - Street 1:240 MEDICAL PARK BLVD
Practice Address - Street 2:STE 3600
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7346
Practice Address - Country:US
Practice Address - Phone:423-990-2414
Practice Address - Fax:423-990-2417
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 6043363LF0000X
VA0024164897363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3348291Medicaid
VA10078431Medicaid
TN103I086169Medicare UPIN
TN3348291Medicaid
TNP00069512Medicare PIN
TN3348291Medicare ID - Type Unspecified
VA10078431Medicaid
TN0281780001Medicare PIN
TNCA5023Medicare PIN