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General NPI Number Information
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NPI Number | 1356810444
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Entity Type | Individual
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Provider Name | TAMERA CASADY
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Gender | Female
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Dates
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Enumeration Date | 11/19/2018
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Last Update Date | 11/19/2018
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Provider Practice Location Address
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Address Line | 131 E 12TH ST UNIT 2542
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City | ADA
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State | OK
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Zip | 74821-7225
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Country | US
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Telephone | 580-235-1508
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Fax |
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Provider Business Mailing Address
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Address Line | 131 E 12TH ST # 2542
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City | ADA
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State | OK
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Zip | 74820-6530
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Country | US
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Telephone | 580-235-1508
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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 | 90638
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License Number State | OK
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