Provider Demographics
NPI:1740211788
Name:WAMPLER, TAMMIE (PA-C)
Entity type:Individual
Prefix:
First Name:TAMMIE
Middle Name:
Last Name:WAMPLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 GLIDEPATH WAY
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37090-4133
Mailing Address - Country:US
Mailing Address - Phone:615-449-5771
Mailing Address - Fax:615-449-5771
Practice Address - Street 1:107 GLIDEPATH WAY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-4133
Practice Address - Country:US
Practice Address - Phone:615-449-5771
Practice Address - Fax:615-449-5740
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000000926363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ052517Medicaid
TN4179722OtherBCBS
MC0820779OtherDEA #
MC0820779OtherDEA #