Provider Demographics
NPI:1245232255
Name:GRABEAL, TAMARA JO (APRN-CNP)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:JO
Last Name:GRABEAL
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-2443
Mailing Address - Country:US
Mailing Address - Phone:580-772-2344
Mailing Address - Fax:580-772-2330
Practice Address - Street 1:1303 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-2443
Practice Address - Country:US
Practice Address - Phone:580-772-2820
Practice Address - Fax:580-772-2845
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0059923363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200013320AMedicaid
OK242328100Medicare ID - Type UnspecifiedMEDICARE SUBMITTER NUMBER
OK200522028Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
OKP98026Medicare UPIN