Provider Demographics
NPI:1669474573
Name:TAMARA HARTSELL, ARNP, PC
Entity Type:Organization
Organization Name:TAMARA HARTSELL, ARNP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:HARTSELL
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:580-772-3030
Mailing Address - Street 1:500 N WASHINGTON ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-5700
Mailing Address - Country:US
Mailing Address - Phone:580-772-3030
Mailing Address - Fax:580-772-3335
Practice Address - Street 1:500 N WASHINGTON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-5700
Practice Address - Country:US
Practice Address - Phone:580-772-3030
Practice Address - Fax:580-772-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0059923363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP98026Medicare UPIN