Provider Demographics
NPI:1720196074
Name:WEBB, TAMMY (ARNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S FRONT AVE
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-1614
Mailing Address - Country:US
Mailing Address - Phone:606-886-8572
Mailing Address - Fax:606-886-8572
Practice Address - Street 1:958 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1346
Practice Address - Country:US
Practice Address - Phone:606-789-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4649P363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000384135OtherANTHEN BC/BS
KY1223569OtherCHA HEALTH
KYQ53326Medicare UPIN
KY0662429Medicare ID - Type Unspecified
KY0366432Medicare ID - Type Unspecified
KY0675726Medicare ID - Type Unspecified
KY1266965Medicare ID - Type Unspecified
KY0371327Medicare ID - Type Unspecified
KY1223569OtherCHA HEALTH
KY000000384135OtherANTHEN BC/BS
KY0675526Medicare ID - Type Unspecified
KY0653327Medicare ID - Type Unspecified