Provider Demographics
NPI:1902213895
Name:ADAMS, TAMMIE JO (RN-BSN, MBA)
Entity Type:Individual
Prefix:MRS
First Name:TAMMIE
Middle Name:JO
Last Name:ADAMS
Suffix:
Gender:F
Credentials:RN-BSN, MBA
Other - Prefix:MRS
Other - First Name:TAMMIE
Other - Middle Name:JO
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-5128
Mailing Address - Country:US
Mailing Address - Phone:601-942-6375
Mailing Address - Fax:
Practice Address - Street 1:225 MOORE ST
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-5128
Practice Address - Country:US
Practice Address - Phone:601-942-6375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-13
Last Update Date:2014-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR889314163WH0200X, 171M00000X, 174H00000X, 372600000X, 3747P1801X, 374U00000X, 376J00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide