Provider Demographics
NPI:1205130945
Name:LANKFORD, TAMARA (PA-C)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:LANKFORD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4775 W PANTHER CREEK DR
Mailing Address - Street 2:SUITE 345
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-3592
Mailing Address - Country:US
Mailing Address - Phone:281-292-1192
Mailing Address - Fax:281-367-0396
Practice Address - Street 1:4775 W PANTHER CREEK DR
Practice Address - Street 2:SUITE 345
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-3592
Practice Address - Country:US
Practice Address - Phone:281-292-1192
Practice Address - Fax:281-367-0396
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04730363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
V0169228OtherDPS
V0169228OtherDPS