Provider Demographics
NPI:1629074992
Name:JARVIS, TAMMY KAY (DO)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:KAY
Last Name:JARVIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-6613
Mailing Address - Country:US
Mailing Address - Phone:405-238-5501
Mailing Address - Fax:405-238-9261
Practice Address - Street 1:100 VALLEY DR
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-6613
Practice Address - Country:US
Practice Address - Phone:405-238-5501
Practice Address - Fax:405-238-9261
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1000097310AMedicaid
243719402Medicare PIN
H44883Medicare UPIN