Provider Demographics
NPI:1669086542
Name:BROWN, TAMMY RAE
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:RAE
Last Name:BROWN
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 1:31315 NORTHWESTERN PIKE
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-7388
Mailing Address - Country:US
Mailing Address - Phone:304-359-4691
Mailing Address - Fax:
Practice Address - Street 1:31315 NORTHWESTERN PIKE
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-7388
Practice Address - Country:US
Practice Address - Phone:304-359-4691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator