Healthcare Provider Details

I. General information

NPI: 1467326413
Provider Name (Legal Business Name): FUSE MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W 7TH ST STE 110
LONDON KY
40741-1763
US

IV. Provider business mailing address

202 W 7TH ST STE 110
LONDON KY
40741-1763
US

V. Phone/Fax

Practice location:
  • Phone: 606-770-5161
  • Fax: 606-770-5168
Mailing address:
  • Phone: 606-770-5161
  • Fax: 606-770-5168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMMY L WHITEHEAD
Title or Position: OWNER
Credential: APRN
Phone: 606-770-5161