Healthcare Provider Details

I. General information

NPI: 1013147842
Provider Name (Legal Business Name): TAMMY LYNN DEXTER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMY LYNN SWINFORD

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 N 14TH ST STE 203
PONCA CITY OK
74601-2039
US

IV. Provider business mailing address

1908 N 14TH ST STE 203
PONCA CITY OK
74601-2039
US

V. Phone/Fax

Practice location:
  • Phone: 580-718-4501
  • Fax: 580-718-4581
Mailing address:
  • Phone: 580-718-4501
  • Fax: 580-718-4581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR0073214
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: