Provider Demographics
NPI:1912339292
Name:BURTON, TAMMY SUE (NP-BC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:SUE
Last Name:BURTON
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:JUDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:600 18TH ST STE 512
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3236
Practice Address - Country:US
Practice Address - Phone:304-424-4574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN42951-FNP-BC363LF0000X
OHCOA.18341-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0148929Medicaid
OHP01604255OtherRAILROAD MEDICARE - MHCPI
WV3810027316Medicaid
WV3810027316Medicaid
OHH472960Medicare PIN