Provider Demographics
NPI:1659858470
Name:RUBICKY, TAMMY POWELL (APRN-FNP-BC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:POWELL
Last Name:RUBICKY
Suffix:
Gender:F
Credentials:APRN-FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3100 MACCORKLE AVE SE STE 902
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1234
Mailing Address - Country:US
Mailing Address - Phone:304-388-6590
Mailing Address - Fax:304-388-6595
Practice Address - Street 1:3100 MACCORKLE AVE SE STE 902
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-388-6590
Practice Address - Fax:304-388-6595
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WVAPRN84476-FNP-BC363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily