Healthcare Provider Details

I. General information

NPI: 1669469243
Provider Name (Legal Business Name): TAMMY L. WHIPPLE MANES M.S.N., F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 09/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E REPUBLIC RD
SPRINGFIELD MO
65804
US

IV. Provider business mailing address

PO BOX 2580
SPRINGFIELD MO
65801-2580
US

V. Phone/Fax

Practice location:
  • Phone: 417-823-4893
  • Fax:
Mailing address:
  • Phone: 417-829-4620
  • Fax: 417-829-4316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number127607
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number127607
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: