1134505647 NPI number — MS. TAMMY WYNETTE PLEMONS

Table of content: MS. TAMMY WYNETTE PLEMONS (NPI 1134505647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134505647 NPI number — MS. TAMMY WYNETTE PLEMONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLEMONS
Provider First Name:
TAMMY
Provider Middle Name:
WYNETTE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAKER
Provider Other First Name:
TAMMY
Provider Other Middle Name:
WYNETTE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
AGNP-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134505647
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3239
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29502-3239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-435-5270
Provider Business Mailing Address Fax Number:
803-433-0154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 E HOSPITAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANNING
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29102-3153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-433-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/06/2015

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: 363LA2200X , with the licence number:  19641 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LG0600X , with the licence number: 19641 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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