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General NPI Number Information
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NPI Number | 1447473533
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Entity Type | Individual
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Provider Name | TAMMY LEA MUNDY FNP
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Gender | Female
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 777 S MAIN ST
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City | CLINTON
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State | IN
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Zip | 47842-2493
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Country | US
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Telephone | 765-828-1003
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Fax | 765-828-1030
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Provider Business Mailing Address
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Address Line | 777 S MAIN ST STE 100
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City | CLINTON
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State | IN
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Zip | 47842-2493
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Country | US
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Telephone | 765-828-1003
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Fax | 812-232-8164
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71000966A
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License Number State | IN
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