Provider Demographics
NPI:1457525909
Name:LUSK, TAMMY DANIELLE
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:DANIELLE
Last Name:LUSK
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TAMMY
Other - Middle Name:DANIELLE
Other - Last Name:MCQUEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:1660 W C PL
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-2705
Mailing Address - Country:US
Mailing Address - Phone:479-219-5008
Mailing Address - Fax:479-219-5025
Practice Address - Street 1:1660 W C PL
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2705
Practice Address - Country:US
Practice Address - Phone:479-219-5008
Practice Address - Fax:479-219-5025
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAO3084 ANP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily