Provider Demographics
NPI:1588170187
Name:CAUTHEN-CROWDER, TAMMY
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:CAUTHEN-CROWDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 OLD LARKSPUR WAY
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-3416
Mailing Address - Country:US
Mailing Address - Phone:919-928-3407
Mailing Address - Fax:
Practice Address - Street 1:205 OLD LARKSPUR WAY
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-3416
Practice Address - Country:US
Practice Address - Phone:919-928-3407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2018-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6341174400000X
6341124Q00000X, 174H00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No174400000XOther Service ProvidersSpecialist
No124Q00000XDental ProvidersDental Hygienist
No174H00000XOther Service ProvidersHealth Educator