Healthcare Provider Details

I. General information

NPI: 1962152611
Provider Name (Legal Business Name): TAMEY DEONE FLEISCHHAUER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BRIERCROFT OFFICE PARK
LUBBOCK TX
79412-3011
US

IV. Provider business mailing address

5410 44TH ST
LUBBOCK TX
79414-1324
US

V. Phone/Fax

Practice location:
  • Phone: 806-795-7433
  • Fax:
Mailing address:
  • Phone: 806-777-4837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF10191001
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: