MEDICARE: TAMMY JEAN BOBBITT-GRAY FNP-C

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	1017380	TX

General Provider Information

NPI Number	:	1891394953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY JEAN BOBBITT-GRAY FNP-C

Provider Business Mailing Address
First Line	:	10801 CHOATE RD
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77507-1503
Country	:	US
Telephone Number	:	713-822-2457
Fax Number	:	281-291-3647

Provider Business Practice Location Address
First Line	:	10801 CHOATE RD
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77507-1503
Country	:	US
Telephone Number	:	713-822-2457
Fax Number	:	281-291-3647

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

Provider Enumeration Date	:	10/20/2020
Last Update Date	:	10/20/2020

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