Tammy Watson Russell

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0038992 Issued in OH

Practice address

969 W 5TH St
Marysville, OH 43040-1070

Phone

(937) 644-3615

NPI assigned

Dec 20, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Longevity Clinical LTC Associates of Ohio, Inc.

  • Gerontology Nurse Practitioner
  • Parma, OH
  • NPI 1114609815

  Single Specialty

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1608422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750982400000",
    "number": "1194311522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "654 CORBEL DR",
            "city": "MARYSVILLE",
            "state": "OH",
            "postal_code": "430407096",
            "telephone_number": "614-749-2189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "969 W 5TH ST",
            "city": "MARYSVILLE",
            "state": "OH",
            "postal_code": "430401070",
            "telephone_number": "937-644-3615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "TAMMY",
        "middle_name": "WATSON",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-20",
        "last_updated": "2025-06-27",
        "certification_date": "2025-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "474767",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "0038992",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mandy Sue Roland
• Kayla M Ross
• Rachel Ross, PT, DPT
• Chad H Routon, MFT, LCDC III
• Rural Anesthesia Management, LLC
• Shawn Kevin Ryan
• S. Richard Scott, DDS, Ms, Inc.
• Julie A Sabo, CNP
• Gina Marie Sabol
• Natalie Salyer, LSW

• Family Nurse Practitioner in Marysville, OH
• Providers in Marysville, OH by specialty
• Family Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.