Healthcare Provider Details

I. General information

NPI: 1740211788
Provider Name (Legal Business Name): TAMMIE WAMPLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 GLIDEPATH WAY
LEBANON TN
37090-4133
US

IV. Provider business mailing address

107 GLIDEPATH WAY
LEBANON TN
37090-4133
US

V. Phone/Fax

Practice location:
  • Phone: 615-449-5771
  • Fax: 615-449-5740
Mailing address:
  • Phone: 615-449-5771
  • Fax: 615-449-5771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0000000926
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA0000000926
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: