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General NPI Number Information
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NPI Number | 1194862961
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Entity Type | Individual
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Provider Name | PATRICIA ALLISON TATUM NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 14355 MIRANDA WAY
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City | LOS ALTOS HILLS
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State | CA
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Zip | 94022-2032
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Country | US
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Telephone | 888-731-8994
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Fax |
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Provider Business Mailing Address
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Address Line | 155 COUNTY ROAD 511
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City | STEPHENVILLE
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State | TX
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Zip | 76401-8064
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Country | US
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Telephone | 254-723-0362
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 650816
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 650816
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License Number State | TX
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