Provider Demographics
NPI:1073960969
Name:ANDERSON, TAMRA LYNN (RN)
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:803 HIGHWAY 31 E
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:TX
Practice Address - Zip Code:75758
Practice Address - Country:US
Practice Address - Phone:903-849-5756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX686940163W00000X
TXAP131822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-041OtherTRICARE
TXP01731693OtherRAIL ROAD MEDICARE
TX365274502Medicaid
TX8333NZOtherBCBS
TX365274501Medicaid
TXP02210535OtherMEDICARE RAIL ROAD
TX778154OtherMEDICARE