Healthcare Provider Details

I. General information

NPI: 1861867194
Provider Name (Legal Business Name): TAMARA CANTRELL R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 OLLIE LOOP
SMITHLAND KY
42081-8969
US

IV. Provider business mailing address

716 OLLIE LOOP
SMITHLAND KY
42081-8969
US

V. Phone/Fax

Practice location:
  • Phone: 270-556-2273
  • Fax: 201-684-9391
Mailing address:
  • Phone: 270-556-2273
  • Fax: 201-684-9391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1083329
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: