Healthcare Provider Details

I. General information

NPI: 1962401265
Provider Name (Legal Business Name): TAMMY CLINE GILLETT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 6TH AVE BLDG B
KINDER LA
70648-3187
US

IV. Provider business mailing address

108 6TH AVE BLDG B
KINDER LA
70648-3187
US

V. Phone/Fax

Practice location:
  • Phone: 337-738-9494
  • Fax: 337-738-9449
Mailing address:
  • Phone: 337-738-9494
  • Fax: 337-738-9494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN054185-AP03062
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: