Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN94099 | TN |
NPI | 1063431781 |
---|---|
Provider Name | Tammy Baird |
First Address | Kingsport, TN 37660-4632 |
Second Address | Rogersville, TN 37857-2441 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 06/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3907664 | (05) | TN |
P76812 | (02) | TN |