Provider Demographics
NPI:1154362143
Name:KITCHENS, TAMMY L (MD)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:KITCHENS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 632476
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2476
Mailing Address - Country:US
Mailing Address - Phone:423-547-9400
Mailing Address - Fax:423-547-9401
Practice Address - Street 1:1503 W ELK AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2876
Practice Address - Country:US
Practice Address - Phone:423-547-9400
Practice Address - Fax:423-547-9401
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD31209208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3859966Medicaid
TN4107454OtherBCBS
TNTN0102OtherJOHN DEERE
TN3859966Medicaid
TN3859966Medicaid