Provider Demographics
NPI:1639273246
Name:GERDES, TAMMY MICHELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:MICHELLE
Last Name:GERDES
Suffix:
Gender:F
Credentials:PA-C
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 182
Mailing Address - Street 2:
Mailing Address - City:BARNARD
Mailing Address - State:VT
Mailing Address - Zip Code:05031-0182
Mailing Address - Country:US
Mailing Address - Phone:802-234-9913
Mailing Address - Fax:802-234-5507
Practice Address - Street 1:1823 VT RTE 107
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:VT
Practice Address - Zip Code:05032-9107
Practice Address - Country:US
Practice Address - Phone:802-234-9913
Practice Address - Fax:802-234-5507
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0550030955363AM0700X
VT0550030954363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0010134OtherMEDICARE PTAN
VT9000412Medicaid