Healthcare Provider Details

I. General information

NPI: 1669891248
Provider Name (Legal Business Name): TAMMY GOULD NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1066 RUTLEDGE PIKE
BLAINE TN
37709
US

IV. Provider business mailing address

1066 RUTLEDGE PIKE
BLAINE TN
37709-3027
US

V. Phone/Fax

Practice location:
  • Phone: 865-933-9477
  • Fax: 865-933-9466
Mailing address:
  • Phone: 865-933-9477
  • Fax: 865-933-9466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000018610
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: