Provider Demographics
NPI:1770672495
Name:CHRISTOPHER, TAMMY (LPN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:CHRISTOPHER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RT. 1 BOX 226
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63633
Mailing Address - Country:US
Mailing Address - Phone:573-366-7793
Mailing Address - Fax:
Practice Address - Street 1:1085 MAPLE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1955
Practice Address - Country:US
Practice Address - Phone:573-756-5353
Practice Address - Fax:573-756-4557
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO046630164W00000X
MO2020005456363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse