Provider Demographics
NPI:1700084480
Name:WELLMAN, TAMARA KAY (NP)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:KAY
Last Name:WELLMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6752 MIDLAND TRAIL ROAD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102
Mailing Address - Country:US
Mailing Address - Phone:606-928-1881
Mailing Address - Fax:606-928-1776
Practice Address - Street 1:6752 MIDLAND TRAIL ROAD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102
Practice Address - Country:US
Practice Address - Phone:606-928-1881
Practice Address - Fax:606-928-1776
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005429363LF0000X
KY5429P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010696Medicaid
KY000000564534OtherANTHEM BCBS
KY000000598315OtherANTHEM BCBS
KY1072499OtherBRICKSTREET
KY000000609846OtherANTHEM BCBS
OH2830093Medicaid
KY7100025700Medicaid
KY0641236Medicare PIN
KY0642923Medicare PIN
OH2830093Medicaid
KY7100025700Medicaid
KY0631728Medicare PIN