1124127253 NPI number — TAMMY DEAN CAYOU CPNP

Table of content: TAMMY DEAN CAYOU CPNP (NPI 1124127253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124127253 NPI number — TAMMY DEAN CAYOU CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAYOU
Provider First Name:
TAMMY
Provider Middle Name:
DEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEAN
Provider Other First Name:
TAMMY
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CPNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124127253
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19450 DEERFIELD AVENUE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LEESBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-723-7337
Provider Business Mailing Address Fax Number:
703-723-6848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19450 DEERFIELD AVENUE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-723-7337
Provider Business Practice Location Address Fax Number:
703-723-6848
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  APN.0003810-NP , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010320372 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010321221 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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