Provider Demographics
NPI:1801823588
Name:BUCHANAN, TOMMIE JO (NP)
Entity Type:Individual
Prefix:
First Name:TOMMIE
Middle Name:JO
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215S COULTER ST 400
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1769
Mailing Address - Country:US
Mailing Address - Phone:806-350-9783
Mailing Address - Fax:806-468-0766
Practice Address - Street 1:1215S COULTER ST 400
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1769
Practice Address - Country:US
Practice Address - Phone:806-350-9783
Practice Address - Fax:806-468-0766
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227085363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS96811Medicare UPIN
TX8A9077Medicare ID - Type Unspecified