Healthcare Provider Details

I. General information

NPI: 1104759216
Provider Name (Legal Business Name): TAMMY J NALLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N ELM ST
HENDERSON KY
42420-3132
US

IV. Provider business mailing address

203 N ELM ST
HENDERSON KY
42420-3132
US

V. Phone/Fax

Practice location:
  • Phone: 270-826-8761
  • Fax: 270-826-8737
Mailing address:
  • Phone: 270-826-8761
  • Fax: 270-826-8737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3239
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: