Provider Demographics
NPI:1659972537
Name:CUNNINGHAM, TAMRA LYNN
Entity Type:Individual
Prefix:MRS
First Name:TAMRA
Middle Name:LYNN
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 N UNION ST.
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1536
Mailing Address - Country:US
Mailing Address - Phone:580-308-5515
Mailing Address - Fax:580-749-5792
Practice Address - Street 1:2225 N UNION ST.
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1536
Practice Address - Country:US
Practice Address - Phone:580-308-5515
Practice Address - Fax:580-749-5792
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist