Provider Demographics
NPI:1952345340
Name:RAY, TAMMY JO (MSN, APRN)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:JO
Last Name:RAY
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:JO
Other - Last Name:IRWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, APRN
Mailing Address - Street 1:851 IRELAND AVENUE
Mailing Address - Street 2:IRELAND ARMY COMMUNITY HOSPITAL-FAMILY PRACTICE CLINIC
Mailing Address - City:FT KNOX
Mailing Address - State:KY
Mailing Address - Zip Code:40121
Mailing Address - Country:US
Mailing Address - Phone:502-624-9278
Mailing Address - Fax:502-624-0256
Practice Address - Street 1:851 IRELAND AVENUE
Practice Address - Street 2:IRELAND ARMY COMMUNITY HOSPITAL-FAMILY PRACTICE CLINIC
Practice Address - City:FT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121
Practice Address - Country:US
Practice Address - Phone:502-624-9278
Practice Address - Fax:502-624-0256
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003812363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1069684OtherKY BOARD OF NURSING: RN
11342952OtherCAQH
11342952OtherCAQH
P88487Medicare UPIN