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General NPI Number Information
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NPI Number | 1316838204
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Entity Type | Individual
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Provider Name | MACY TILLMAN APRN
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Gender | Female
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Dates
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Enumeration Date | 07/10/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 203 WATSON ST STE 200
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City | PRATT
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State | KS
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Zip | 67124-3092
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Country | US
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Telephone | 620-672-7422
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Fax | 855-884-8184
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Provider Business Mailing Address
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Address Line | PO BOX 308
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City | PRATT
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State | KS
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Zip | 67124-0308
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Country | US
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Telephone | 620-672-7422
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Fax | 855-884-8184
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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 | 53-84535-072
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License Number State | KS
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