Provider Demographics
NPI:1679519136
Name:MEYER, TAMERA KIM (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMERA
Middle Name:KIM
Last Name:MEYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TAMERA
Other - Middle Name:KIM
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:245 FOUNTAIN COURT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1810
Mailing Address - Country:US
Mailing Address - Phone:859-323-6861
Mailing Address - Fax:859-323-1194
Practice Address - Street 1:245 FOUNTAIN CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509
Practice Address - Country:US
Practice Address - Phone:859-323-6861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY502492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009942883Medicaid
AL009911007Medicaid
AL051557677Medicaid
AL51595915OtherBCBS
MS07706744Medicaid
AL51595912OtherBCBS
AL51595914OtherBCBS
AL009938674Medicaid
AL51100055OtherBCBS
AL009938611Medicaid
AL51595916OtherBCBS
AL009938673Medicaid
AL51595911OtherBCBS
AL51595913OtherBCBS
AL51100055OtherBCBS
AL51595915OtherBCBS