Healthcare Provider Details

I. General information

NPI: 1326464330
Provider Name (Legal Business Name): TAMMY HULBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5416 GARDENDALE ST.
MEMPHIS TN
38141
US

IV. Provider business mailing address

5416 GARDENDALE ST.
MEMPHIS TN
38141
US

V. Phone/Fax

Practice location:
  • Phone: 901-497-9177
  • Fax: 901-270-4594
Mailing address:
  • Phone: 901-497-9177
  • Fax: 901-270-4594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: