Provider Demographics
NPI:1083017511
Name:KILLOUGH, TAMARA DENIECE (FNP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:DENIECE
Last Name:KILLOUGH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:DENIECE
Other - Last Name:HALFMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7571 STATE HIGHWAY 153
Mailing Address - Street 2:
Mailing Address - City:WINTERS
Mailing Address - State:TX
Mailing Address - Zip Code:79567-7439
Mailing Address - Country:US
Mailing Address - Phone:325-754-1317
Mailing Address - Fax:325-754-1208
Practice Address - Street 1:7571 STATE HIGHWAY 153
Practice Address - Street 2:
Practice Address - City:WINTERS
Practice Address - State:TX
Practice Address - Zip Code:79567-7439
Practice Address - Country:US
Practice Address - Phone:325-754-1317
Practice Address - Fax:325-754-1208
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126526363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily