Provider Demographics
NPI:1720006315
Name:SMITH, TAMMY (NP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16416 SPANISH CT
Mailing Address - Street 2:SUITE 1004-154
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-5936
Mailing Address - Country:US
Mailing Address - Phone:225-938-0593
Mailing Address - Fax:
Practice Address - Street 1:20372 GREENWELL SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739-5513
Practice Address - Country:US
Practice Address - Phone:225-819-8857
Practice Address - Fax:225-767-6822
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LARN066127 AP04327363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1466379Medicaid
LAQ61567Medicare UPIN
LA1466379Medicaid
LA4H741C822Medicare PIN