Basic Information
| Provider Information | |||||||||
| NPI: | 1811039209 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARMAN | ||||||||
| FirstName: | TAMMY | ||||||||
| MiddleName: | DARLENE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 2412 RING RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427015912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707692273 | ||||||||
| FaxNumber: | 2707692244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 09/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 1059598 | KY | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 3378P | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 3003378 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 300034557 | 05 | IN | MEDICAID | 1152216 | 01 | KY | PASSPORT | OTHER | 7140259 | 01 | KY | AETNA | OTHER | 78006657 | 05 | KY | MEDICAID | 000000211120 | 01 | KY | ANTHEM | OTHER | 1213007 | 01 | KY | CHA | OTHER | 500023710 | 01 | KY | RAILROAD MEDICARE | OTHER | 2438667000 | 01 | KY | PASSPORT ADVANTAGE | OTHER |