Provider Demographics
NPI:1104867837
Name:MASON, TAMARAH (CRNP)
Entity Type:Individual
Prefix:
First Name:TAMARAH
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:CRNP
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 570
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36702-0570
Mailing Address - Country:US
Mailing Address - Phone:334-375-8007
Mailing Address - Fax:334-877-4763
Practice Address - Street 1:203 VAUGHAN MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6950
Practice Address - Country:US
Practice Address - Phone:334-375-8007
Practice Address - Fax:334-526-1849
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-049707363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630902049Medicaid
AL630904049Medicaid
AL630900049Medicaid
AL511-52699OtherBCBS
AL630902049Medicaid