Provider Demographics
NPI:1811039209
Name:CARMAN, TAMMY DARLENE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:DARLENE
Last Name:CARMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:2412 RING RD STE 100
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-5912
Practice Address - Country:US
Practice Address - Phone:270-769-2273
Practice Address - Fax:270-769-2244
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1059598163W00000X
KY3378P363LF0000X
KY3003378363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300034557Medicaid
KY1152216OtherPASSPORT
KY7140259OtherAETNA
KY78006657Medicaid
KY000000211120OtherANTHEM
KY1213007OtherCHA
KY500023710OtherRAILROAD MEDICARE
KY2438667000OtherPASSPORT ADVANTAGE