Provider Demographics
NPI:1689121147
Name:TILLMAN, AMY MICHELLE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 N 8TH ST
Mailing Address - Street 2:PO BOX 431
Mailing Address - City:HOLLIS
Mailing Address - State:OK
Mailing Address - Zip Code:73550-2026
Mailing Address - Country:US
Mailing Address - Phone:580-688-2200
Mailing Address - Fax:580-688-2229
Practice Address - Street 1:920 N 8TH
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:OK
Practice Address - Zip Code:73550
Practice Address - Country:US
Practice Address - Phone:580-688-2200
Practice Address - Fax:580-688-2229
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK120820363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily