Provider Demographics
NPI:1679526768
Name:DAILEY, TAMMY S (PA)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:S
Last Name:DAILEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:S
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 844
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15900 LA CANTERA PKWY, STE 20265
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256
Practice Address - Country:US
Practice Address - Phone:210-314-4740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02330363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J6727Medicare PIN
TX8D2006Medicare PIN
TX8D5113Medicare PIN
TXP39669Medicare UPIN
TX86N969Medicare PIN