Provider Demographics
NPI:1780193524
Name:WHITEHEAD, TAMMY (APRN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:ARMENTROUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 1219
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-7219
Mailing Address - Country:US
Mailing Address - Phone:512-715-3106
Mailing Address - Fax:325-388-6935
Practice Address - Street 1:525 RANCH ROAD 2900
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:TX
Practice Address - Zip Code:78639-6000
Practice Address - Country:US
Practice Address - Phone:512-715-3106
Practice Address - Fax:325-388-6935
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135447363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily