Healthcare Provider Details

I. General information

NPI: 1972089357
Provider Name (Legal Business Name): TAMMI CAWTHRA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 N CHEYENNE ST
BENKELMAN NE
69021-3074
US

IV. Provider business mailing address

PO BOX 626
BENKELMAN NE
69021-0626
US

V. Phone/Fax

Practice location:
  • Phone: 308-423-2204
  • Fax: 308-423-5691
Mailing address:
  • Phone: 308-423-2204
  • Fax: 308-423-5691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number112568
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: