Basic Information
| Provider Information | |||||||||
| NPI: | 1679519136 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEYER | ||||||||
| FirstName: | TAMERA | ||||||||
| MiddleName: | KIM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MEYER | ||||||||
| OtherFirstName: | TAMERA | ||||||||
| OtherMiddleName: | KIM | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 245 FOUNTAIN COURT | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405091810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593236861 | ||||||||
| FaxNumber: | 8593231194 | ||||||||
| Practice Location | |||||||||
| Address1: | 245 FOUNTAIN CT | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593236861 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 06/29/2018 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 50249 | KY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 009942883 | 05 | AL | MEDICAID | 009911007 | 05 | AL | MEDICAID | 051557677 | 05 | AL | MEDICAID | 51595915 | 01 | AL | BCBS | OTHER | 07706744 | 05 | MS | MEDICAID | 51595912 | 01 | AL | BCBS | OTHER | 51595914 | 01 | AL | BCBS | OTHER | 009938674 | 05 | AL | MEDICAID | 51100055 | 01 | AL | BCBS | OTHER | 009938611 | 05 | AL | MEDICAID | 51595916 | 01 | AL | BCBS | OTHER | 009938673 | 05 | AL | MEDICAID | 51595911 | 01 | AL | BCBS | OTHER | 51595913 | 01 | AL | BCBS | OTHER |