Individual
TAMMY K. HART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
400 N FULLERTON ST, PRINCETON, MO 64673-1418
(660) 748-4040
(660) 748-4042
Mailing address
400 N FULLERTON ST, PRINCETON, MO 64673-1418
(660) 748-4040
(660) 748-4042
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD100333
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10001195600
COMMUNITY HEALTH PLAN
MO
05
—
203716626
—
MO
01
—
20710041
BCBS
MO
01
—
240969
FREEDOM NETWORK
MO
05
—
593909203
—
MO
01
—
J120000
MEDICARE GROUP NUMBER
MO
Enumeration date
04/27/2006
Last updated
11/04/2010
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