Provider Demographics
NPI:1023105780
Name:FREEMAN, TAMMY L (APRN)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:L
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10755 N US HIGHWAY 25E
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:KY
Mailing Address - Zip Code:40734-6529
Mailing Address - Country:US
Mailing Address - Phone:606-258-8050
Mailing Address - Fax:606-258-8994
Practice Address - Street 1:10755 N US HIGHWAY 25E
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:KY
Practice Address - Zip Code:40734-6529
Practice Address - Country:US
Practice Address - Phone:606-258-8050
Practice Address - Fax:606-258-8994
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002597363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY500012796OtherRR MC
KY78259702Medicaid
KY000000106936OtherANTHEM
KY000000106936OtherANTHEM
KY78259702Medicaid