Healthcare Provider Details

I. General information

NPI: 1851531818
Provider Name (Legal Business Name): TAMMY A PAYNE HAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMMY DEAN

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 MALVERN AVE STE C
HOT SPRINGS AR
71901-6375
US

IV. Provider business mailing address

1029 SLATECREEK WAY
LONSDALE AR
72087-9710
US

V. Phone/Fax

Practice location:
  • Phone: 501-701-4388
  • Fax:
Mailing address:
  • Phone: 501-276-3431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number605
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: