MEDICARE: MS. TAMRA P WARD APNBC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AO2947	AR

General Provider Information

NPI Number	:	1205937695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMRA P WARD APNBC

Provider Business Mailing Address
First Line	:	350 MAIN ST
Second Line	:	SUITE 4
City	:	MAMMOTH SPRING
State	:	AR
Zip	:	72554-7423
Country	:	US
Telephone Number	:	870-625-3111
Fax Number	:	870-625-3118

Provider Business Practice Location Address
First Line	:	350 S MAIN ST
Second Line	:	SUITE 4
City	:	MAMMOTH SPRING
State	:	AR
Zip	:	72554-7423
Country	:	US
Telephone Number	:	870-625-3111
Fax Number	:	870-625-3118

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	05/19/2011

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