Provider Demographics
NPI:1922578707
Name:DEGENHARDT, TAMARA JANE CAROL DAWN (APRN)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:JANE CAROL DAWN
Last Name:DEGENHARDT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:JANE CAROL DAWN
Other - Last Name:SCHMID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:809 FIREFORK AVE
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-0504
Mailing Address - Country:US
Mailing Address - Phone:405-985-9940
Mailing Address - Fax:
Practice Address - Street 1:4205 OK-66
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-4909
Practice Address - Country:US
Practice Address - Phone:405-262-4875
Practice Address - Fax:405-319-7675
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK91127363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK91127OtherBOARD OF NURSING LICENSE NUMBER