Provider Demographics
NPI:1528031655
Name:WILLIAMS, TAMMY MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:MICHELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:MICHELLE
Other - Last Name:TAPLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:601 SE WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-3319
Mailing Address - Country:US
Mailing Address - Phone:580-286-6688
Mailing Address - Fax:580-286-6699
Practice Address - Street 1:601 SE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-3319
Practice Address - Country:US
Practice Address - Phone:580-286-6688
Practice Address - Fax:580-286-6699
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA 1240363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200004690AMedicaid