Provider Demographics
NPI:1801118856
Name:BERERA, TAMMY LYNN SALVATORE (ARNP)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:LYNN SALVATORE
Last Name:BERERA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:120 N EAGLE CREEK DR
Mailing Address - Street 2:SUITE 460
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1827
Mailing Address - Country:US
Mailing Address - Phone:859-263-7248
Mailing Address - Fax:
Practice Address - Street 1:120 N EAGLE CREEK DR
Practice Address - Street 2:SUITE 460
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1827
Practice Address - Country:US
Practice Address - Phone:859-263-7248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2014-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014834363LA2100X
KY3006126P363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100166930Medicaid
KY7100166930Medicaid