Healthcare Provider Details

I. General information

NPI: 1730417593
Provider Name (Legal Business Name): TAM HEALTHCARE OPTIONS, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2009
Last Update Date: 12/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 CRUMS LN
LOUISVILLE KY
40216-4228
US

IV. Provider business mailing address

5407 GALAXIE DR
LOUISVILLE KY
40258-3329
US

V. Phone/Fax

Practice location:
  • Phone: 502-299-1827
  • Fax:
Mailing address:
  • Phone: 502-299-1827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4354
License Number StateKY

VIII. Authorized Official

Name: CONTINA ANGELENE MCCLAIN-PATTON
Title or Position: NURSE PRACTITIONER
Credential: ARNP
Phone: 502-299-1827