Provider Demographics
NPI:1316838204
Name:TILLMAN, MACY (APRN)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:APRN
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 308
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124-0308
Mailing Address - Country:US
Mailing Address - Phone:620-672-7422
Mailing Address - Fax:855-884-8184
Practice Address - Street 1:203 WATSON ST STE 200
Practice Address - Street 2:
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124-3092
Practice Address - Country:US
Practice Address - Phone:620-672-7422
Practice Address - Fax:855-884-8184
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-84535-072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily