Provider Demographics
NPI:1346633005
Name:WISCHKAEMPER, TABRA DEE (FNP)
Entity Type:Individual
Prefix:
First Name:TABRA
Middle Name:DEE
Last Name:WISCHKAEMPER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4321 MARSHA SHARP FWY
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-2504
Mailing Address - Country:US
Mailing Address - Phone:806-797-2139
Mailing Address - Fax:806-797-3105
Practice Address - Street 1:5902 66TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3048
Practice Address - Country:US
Practice Address - Phone:806-797-2139
Practice Address - Fax:806-797-3105
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP127467363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX401542YP54Medicare PIN