Provider Demographics
NPI:1427158187
Name:STROUD, TAMARA L (APRN)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:STROUD
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 1:444 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-2871
Mailing Address - Country:US
Mailing Address - Phone:270-821-4444
Mailing Address - Fax:270-821-9188
Practice Address - Street 1:444 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-2871
Practice Address - Country:US
Practice Address - Phone:270-821-4444
Practice Address - Fax:270-821-9188
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002704363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000496444OtherBCBS PIN - CHS INC
KY7800517000Medicaid
KYP03342685Medicare PIN
KY000000496444OtherBCBS PIN - CHS INC
KYS56763Medicare UPIN