Provider Demographics
NPI:1770054314
Name:WINGETT, TAMMY K
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:K
Last Name:WINGETT
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 1:1922 PINEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-1720
Mailing Address - Country:US
Mailing Address - Phone:307-532-2366
Mailing Address - Fax:
Practice Address - Street 1:1922 PINEY CREEK RD
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-1720
Practice Address - Country:US
Practice Address - Phone:307-532-2366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No372600000XNursing Service Related ProvidersAdult Companion
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child