Provider Demographics
NPI:1184269599
Name:CALLAHAN, TAMELA RENAE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:TAMELA
Middle Name:RENAE
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20188 RIDGEROCK DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:TX
Mailing Address - Zip Code:75762-9335
Mailing Address - Country:US
Mailing Address - Phone:903-521-0015
Mailing Address - Fax:
Practice Address - Street 1:20188 RIDGEROCK DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:TX
Practice Address - Zip Code:75762-9335
Practice Address - Country:US
Practice Address - Phone:903-521-0015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143797363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily