Provider Demographics
NPI:1063431781
Name:BAIRD, TAMMY (WHNP)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:BAIRD
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 EXECUTIVE PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4632
Mailing Address - Country:US
Mailing Address - Phone:423-224-3258
Mailing Address - Fax:423-224-3258
Practice Address - Street 1:405 SCENIC DR
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-2441
Practice Address - Country:US
Practice Address - Phone:423-272-2111
Practice Address - Fax:423-224-3233
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN94099363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3907664Medicaid
TNP76812Medicare UPIN
TN3907664Medicare PIN
TN10350I2908Medicare PIN