Provider Demographics
NPI:1366677536
Name:POTEAT, TAMARA ANASTASIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:ANASTASIA
Last Name:POTEAT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:TAMARA
Other - Middle Name:ANASTASIA
Other - Last Name:WOODSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:825 NE 10TH ST
Mailing Address - Street 2:SUITE 3300
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5417
Mailing Address - Country:US
Mailing Address - Phone:405-271-9493
Mailing Address - Fax:
Practice Address - Street 1:825 NE 10TH ST
Practice Address - Street 2:SUITE 3300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5417
Practice Address - Country:US
Practice Address - Phone:405-271-9493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1819363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant