Tammy Bennett, NURSE PRACTITIONER
Individual provider Active NPI Adult Health Nurse Practitioner · Greenville, SC
NPI 1013090786 · NPPES record last updated Feb 16, 2016
Key facts
- NPI
- 1013090786
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- 3073 (SC)
- Practice address
- 1757 Woodruff Rd
Greenville, SC 29607-6943 - Phone
- (864) 458-9288
- Fax
- (864) 458-9289
- NPI assigned
- Oct 24, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070227000736 | SC | Practitioner - Nurse Practitioner | 6800998527 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Openloop Healthcare Partners PC | Current |
Accepting new patients |
Locations
317 6th Ave
Ste 400
Des Moines, IA 50309
Phone (515) 612-9097
525 N Tryon St
Ste 1600
Charlotte, NC 28202
Phone (855) 478-8208
2 Office Park Ct
Columbia, SC 29223
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 3073 | SC | Yes |
Addresses
Primary practice location
1757 Woodruff Rd
Greenville, SC 29607-6943
Mailing address
1757 Woodruff Rd
Greenville, SC 29607-6943
Phone (864) 458-9288
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NP1077 | Medicaid | SC |
Other providers in Greenville, SC
- Albert C Bennett
- Elizabeth Bennett
- Kyle Magee Bennett
- Laine Bennett
- Megan I. Bennett
- Vanisha Bennett
- Braeden Ann Lee Bensch
- Emily Rea Benson
- Gabri Michelle Benson
- Taylor Benson
All providers in Greenville, SC · Adult Health Nurse Practitioner in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 16, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.