Provider Demographics
NPI:1962401265
Name:GILLETT, TAMMY CLINE (NP)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:CLINE
Last Name:GILLETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 6TH AVE BLDG B
Mailing Address - Street 2:
Mailing Address - City:KINDER
Mailing Address - State:LA
Mailing Address - Zip Code:70648-3187
Mailing Address - Country:US
Mailing Address - Phone:337-738-9494
Mailing Address - Fax:337-738-9494
Practice Address - Street 1:108 6TH AVE BLDG B
Practice Address - Street 2:
Practice Address - City:KINDER
Practice Address - State:LA
Practice Address - Zip Code:70648-3187
Practice Address - Country:US
Practice Address - Phone:337-738-9494
Practice Address - Fax:337-738-9449
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN054185-AP03062363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1547344Medicaid
P13507Medicare UPIN
LA1547344Medicaid