Provider Demographics
NPI:1366572695
Name:EDDY, TOMMY CLIFTON (RN)
Entity type:Individual
Prefix:MR
First Name:TOMMY
Middle Name:CLIFTON
Last Name:EDDY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 COUNTY ROAD 2141
Mailing Address - Street 2:
Mailing Address - City:HARTMAN
Mailing Address - State:AR
Mailing Address - Zip Code:72840
Mailing Address - Country:US
Mailing Address - Phone:479-497-2350
Mailing Address - Fax:
Practice Address - Street 1:1151 S ROGERS ST
Practice Address - Street 2:SUITE 7 & 8
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-9158
Practice Address - Country:US
Practice Address - Phone:479-754-5511
Practice Address - Fax:479-754-5545
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR36967163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health