Healthcare Provider Details

I. General information

NPI: 1942336946
Provider Name (Legal Business Name): TAMMY MICHELLE DRIVER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 HIGHWAY 52 BYPASS EAST TN DEPT OF HEALTH
LAFAYETTE TN
37083
US

IV. Provider business mailing address

189 DIXON RD
LAFAYETTE TN
37083-4921
US

V. Phone/Fax

Practice location:
  • Phone: 615-666-2142
  • Fax: 615-666-6153
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 0000121406
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: