Tammy Lynn Wilson, AGACNP
Individual provider Active NPI Adult Medicine Physician · Laceys Spring, AL
NPI 1235703240 · NPPES record last updated Oct 12, 2022
Key facts
- NPI
- 1235703240
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Medicine Physician 207QA0505X
- License
- 1-127155 (AL)
- Practice address
- 4258 Highway 231 Ste 5
Laceys Spring, AL 35754-6444 - Phone
- (256) 498-6500
- Fax
- (256) 970-2929
- NPI assigned
- May 14, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
- 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 |
|---|---|---|---|---|
| I20211021002199 | AL | Practitioner - Nurse Practitioner | 6305234485 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13227637 | AL | MD | Acute Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Valley Sunrise LLC | Current |
Accepting new patients |
Locations
4258 Highway 231
Ste 5
Laceys Spring, AL 35754
Phone (256) 498-5770
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | 1-127155 | AL | |
| Acute Care Nurse Practitioner | 363LA2100X | 13227637 | AL | |
| Adult Medicine Physician | 207QA0505X | 1-127155 | AL | Yes |
Addresses
Primary practice location
4258 Highway 231 Ste 5
Laceys Spring, AL 35754-6444
Mailing address
4258 Highway 231 Ste 5
Laceys Spring, AL 35754-6444
Phone (256) 498-6500
Other providers in Laceys Spring, AL
- Leslie Lalane Phillips
- Valley Sunrise LLC
- Vivian N Hannon
- Leah Tucker Walsh
- Catharine B Willis
- Breanna Wootson
- Rebecca Dianna Worsham
All providers in Laceys Spring, AL · Adult Medicine Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 12, 2022. 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.