Healthcare Provider Details

I. General information

NPI: 1528031655
Provider Name (Legal Business Name): TAMMY MICHELLE WILLIAMS P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMY MICHELLE TAPLEY P.A.-C.

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SE WASHINGTON ST
IDABEL OK
74745-3319
US

IV. Provider business mailing address

601 SE WASHINGTON ST
IDABEL OK
74745-3319
US

V. Phone/Fax

Practice location:
  • Phone: 580-286-6688
  • Fax: 580-286-6699
Mailing address:
  • Phone: 580-286-6688
  • Fax: 580-286-6699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 1240
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: