Healthcare Provider Details

I. General information

NPI: 1568373637
Provider Name (Legal Business Name): TAMMY WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 LOCKHEED DR
BEAVER WV
25813-8962
US

IV. Provider business mailing address

106 LOCKHEED DR
BEAVER WV
25813-8962
US

V. Phone/Fax

Practice location:
  • Phone: 304-253-5155
  • Fax:
Mailing address:
  • Phone: 304-253-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number80851
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: