Healthcare Provider Details

I. General information

NPI: 1831862333
Provider Name (Legal Business Name): TAMRA JEAN PRESTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 S INDIANA AVE
ENGLISH IN
47118-5851
US

IV. Provider business mailing address

1389 N COUNTY ROAD 125 W
PAOLI IN
47454-9641
US

V. Phone/Fax

Practice location:
  • Phone: 812-338-2924
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71011343A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71011343A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: