1356568562 NPI number — MRS. TAMMY L MYERS M.S. CCC SLP

Table of content: MRS. TAMMY L MYERS M.S. CCC SLP (NPI 1356568562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356568562 NPI number — MRS. TAMMY L MYERS M.S. CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MYERS
Provider First Name:
TAMMY
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S. CCC SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KING, MCCALL
Provider Other First Name:
TAMMY
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S, CCC/SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356568562
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 313
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72933-0313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-965-6704
Provider Business Mailing Address Fax Number:
479-965-1220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 S GREENWOOD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-965-6704
Provider Business Practice Location Address Fax Number:
479-965-1220
Provider Enumeration Date:
04/19/2007

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: 235Z00000X , with the licence number:  648 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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