MEDICARE: TAMMY BAIRD WHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	RN94099	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063431781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY BAIRD WHNP

Provider Business Mailing Address
First Line	:	999 EXECUTIVE PARK BLVD
Second Line	:	SUITE 201
City	:	KINGSPORT
State	:	TN
Zip	:	37660-4632
Country	:	US
Telephone Number	:	423-224-3258
Fax Number	:	423-224-3258

Provider Business Practice Location Address
First Line	:	405 SCENIC DR
Second Line	:
City	:	ROGERSVILLE
State	:	TN
Zip	:	37857-2441
Country	:	US
Telephone Number	:	423-272-2111
Fax Number	:	423-224-3233

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	08/06/2012

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