Healthcare Provider Details

I. General information

NPI: 1386619856
Provider Name (Legal Business Name): TAMMIE D REGGIO P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMMIE D MANESS P.A.

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E SW 59TH ST
MUSTANG OK
73064-4722
US

IV. Provider business mailing address

4300 CARAVEL DR APT 1115
YUKON OK
73099-3782
US

V. Phone/Fax

Practice location:
  • Phone: 405-757-7818
  • Fax: 405-703-0645
Mailing address:
  • Phone: 580-716-0245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number981
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number981
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number981
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: