Healthcare Provider Details

I. General information

NPI: 1649231119
Provider Name (Legal Business Name): TAMMY K MAYER RN, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 3RD ST
FORT POLK LA
71459-5102
US

IV. Provider business mailing address

1585 3RD ST
FORT POLK LA
71459-5102
US

V. Phone/Fax

Practice location:
  • Phone: 337-531-4740
  • Fax: 337-531-6764
Mailing address:
  • Phone: 337-531-4740
  • Fax: 337-531-6764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number135276
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: