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General NPI Number Information
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NPI Number | 1508405309
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Entity Type | Organization
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Legal Business Name | TAMMY WAGSTAFF, DNP, APRN-CNP, PLLC
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Dates
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Enumeration Date | 12/27/2019
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Last Update Date | 12/27/2019
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Provider Practice Location Address
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Address Line | 5705 NW 132ND ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73142-4437
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Country | US
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Telephone | 405-409-2897
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Fax |
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Provider Business Mailing Address
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Address Line | 16208 JULIET DR
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City | EDMOND
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State | OK
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Zip | 73013-9235
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Country | US
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Telephone | 405-409-2897
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAMMY L WAGSTAFF
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Credential | DNP, APRN-CNP
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Telephone | 405-409-2897
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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