Provider Demographics
NPI:1932401866
Name:GLENN, TAMMY (LPN, MHPP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:GLENN
Suffix:
Gender:F
Credentials:LPN, MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LAWRENCE 234 ROAD
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:AR
Mailing Address - Zip Code:72458
Mailing Address - Country:US
Mailing Address - Phone:870-759-2460
Mailing Address - Fax:
Practice Address - Street 1:503 SE LINDSEY ST
Practice Address - Street 2:
Practice Address - City:HOXIE
Practice Address - State:AR
Practice Address - Zip Code:72433-2224
Practice Address - Country:US
Practice Address - Phone:870-886-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator