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NPI Code Detail

MEDICARE: TAMULA K MAXWELL PA-C

MEDICARE: TAMULA K MAXWELL PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant2003006425MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12003006425OTHERMOLICENSE NUMBER

General Provider Information

NPI Number : 1255303681
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMULA K MAXWELL PA-C
Provider Business Mailing Address
First Line : 26180 E STATE HIGHWAY MM
Second Line :
City : GILMAN CITY
State : MO
Zip : 64642-8139
Country : US
Telephone Number : 660-425-2365
Fax Number :
Provider Business Practice Location Address
First Line : 3202 MILLER ST
Second Line :
City : BETHANY
State : MO
Zip : 64424-2713
Country : US
Telephone Number : 660-425-3154
Fax Number : 660-425-6663
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2006
Last Update Date : 06/24/2026

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