Provider Demographics
NPI:1316530942
Name:HENSON, TAMMY BURLESON (RN, BSN)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:BURLESON
Last Name:HENSON
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:RENEA
Other - Last Name:BURLESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:CROSSNORE
Mailing Address - State:NC
Mailing Address - Zip Code:28616-0249
Mailing Address - Country:US
Mailing Address - Phone:828-733-4318
Mailing Address - Fax:828-733-4210
Practice Address - Street 1:100 DAR DR
Practice Address - Street 2:
Practice Address - City:NEWLAND
Practice Address - State:NC
Practice Address - Zip Code:28657-9862
Practice Address - Country:US
Practice Address - Phone:828-733-4318
Practice Address - Fax:828-733-4210
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC154252163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice