Provider Demographics
NPI:1265439202
Name:NIEMEIER, TAMARA DAWN (ARNP)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:DAWN
Last Name:NIEMEIER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:DAWN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:57 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2746
Mailing Address - Country:US
Mailing Address - Phone:606-528-9700
Mailing Address - Fax:606-528-8423
Practice Address - Street 1:57 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2746
Practice Address - Country:US
Practice Address - Phone:606-528-9700
Practice Address - Fax:606-528-8423
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002218363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78001344Medicaid
570316Medicare UPIN
KY0691806Medicare PIN