MEDICARE: MRS. TAMARA JO GRABEAL APRN-CNP

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	R0059923	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245232255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMARA JO GRABEAL APRN-CNP

Provider Business Mailing Address
First Line	:	701 CEDAR LAKE BLVD STE 120
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-7815
Country	:	US
Telephone Number	:	405-445-1210
Fax Number	:	580-203-3464

Provider Business Practice Location Address
First Line	:	1303 N WASHINGTON ST
Second Line	:
City	:	WEATHERFORD
State	:	OK
Zip	:	73096-2443
Country	:	US
Telephone Number	:	580-772-2820
Fax Number	:	580-772-2845

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	05/17/2024

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