Provider Demographics
NPI:1447897343
Name:WOODBURN, TAMMY DAWN (APRN)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:DAWN
Last Name:WOODBURN
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 1:6475 FARMDALE RD
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1321
Mailing Address - Country:US
Mailing Address - Phone:304-529-7004
Mailing Address - Fax:
Practice Address - Street 1:6475 FARMDALE RD
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1321
Practice Address - Country:US
Practice Address - Phone:304-529-7004
Practice Address - Fax:304-529-7303
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014010363LF0000X
WV110322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily