Provider Demographics
NPI:1215981279
Name:KELLOGG, TAMMY S (CRNA)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:S
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 WEST AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-5107
Mailing Address - Country:US
Mailing Address - Phone:931-456-4433
Mailing Address - Fax:931-456-4405
Practice Address - Street 1:1307 WEST AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-5107
Practice Address - Country:US
Practice Address - Phone:931-456-4433
Practice Address - Fax:931-456-4405
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106290367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN106290OtherRN LICENSE