Provider Demographics
NPI:1336748573
Name:MCKEEHAN, TAMMY DAWN
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:DAWN
Last Name:MCKEEHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29970 HIGHWAY 84
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-8539
Mailing Address - Country:US
Mailing Address - Phone:501-337-2262
Mailing Address - Fax:
Practice Address - Street 1:29888 HIGHWAY 84
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-8538
Practice Address - Country:US
Practice Address - Phone:501-337-2622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider