Provider Demographics
NPI:1861994543
Name:SMITH, TAMMY MAE (RN)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:MAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 DORIS LN
Mailing Address - Street 2:
Mailing Address - City:GUNTER
Mailing Address - State:TX
Mailing Address - Zip Code:75058-2550
Mailing Address - Country:US
Mailing Address - Phone:817-403-8157
Mailing Address - Fax:
Practice Address - Street 1:707 DORIS LN
Practice Address - Street 2:
Practice Address - City:GUNTER
Practice Address - State:TX
Practice Address - Zip Code:75058-2550
Practice Address - Country:US
Practice Address - Phone:817-403-8157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX587398163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse