Provider Demographics
NPI:1447473533
Name:MUNDY, TAMMY LEA (FNP)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LEA
Last Name:MUNDY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2723 SOUTH 7TH STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802
Mailing Address - Country:US
Mailing Address - Phone:812-238-1730
Mailing Address - Fax:812-242-1565
Practice Address - Street 1:777 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IN
Practice Address - Zip Code:47842-2493
Practice Address - Country:US
Practice Address - Phone:765-828-1003
Practice Address - Fax:765-828-1030
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2016-05-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71000966A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200846710Medicaid
INP00416616OtherRAILROAD MEDICARE
INP00416616OtherRAILROAD MEDICARE
IN200846710Medicaid