Provider Demographics
NPI:1417942186
Name:MEISEL, TAMARA T (ARNP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:T
Last Name:MEISEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 W RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:LAKIN
Mailing Address - State:KS
Mailing Address - Zip Code:67860-9788
Mailing Address - Country:US
Mailing Address - Phone:620-355-7589
Mailing Address - Fax:620-275-4729
Practice Address - Street 1:712 SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5128
Practice Address - Country:US
Practice Address - Phone:620-275-1766
Practice Address - Fax:620-275-4729
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44686363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4286710801Medicaid
KS060247OtherBC/BS PROVIDER NUMBER
KS171813Medicare PIN
KS060247OtherBC/BS PROVIDER NUMBER
KS171810Medicare PIN
KS171815Medicare PIN