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General NPI Number Information
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NPI Number | 1528031655
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Entity Type | Individual
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Provider Name | TAMMY MICHELLE WILLIAMS P.A.-C
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Gender | Female
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 12/12/2013
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Provider Practice Location Address
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Address Line | 601 SE WASHINGTON ST
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City | IDABEL
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State | OK
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Zip | 74745-3319
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Country | US
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Telephone | 580-286-6688
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Fax | 580-286-6699
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Provider Business Mailing Address
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Address Line | 601 SE WASHINGTON ST
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City | IDABEL
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State | OK
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Zip | 74745-3319
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Country | US
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Telephone | 580-286-6688
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Fax | 580-286-6699
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 1240
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License Number State | OK
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