Provider Demographics
NPI:1649331281
Name:FARMER, TAMARA L (ARNP)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:L
Last Name:FARMER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:TAMARA
Other - Middle Name:L
Other - Last Name:MACKIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:802 WEST BROADWAY
Mailing Address - Street 2:PO BOX 309
Mailing Address - City:STAFFORD
Mailing Address - State:KS
Mailing Address - Zip Code:67578-0309
Mailing Address - Country:US
Mailing Address - Phone:620-234-6826
Mailing Address - Fax:620-234-5014
Practice Address - Street 1:802 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:KS
Practice Address - Zip Code:67578-0309
Practice Address - Country:US
Practice Address - Phone:620-234-6826
Practice Address - Fax:620-234-5014
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2010-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-74829-122364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200001360BMedicaid
KS200001360BMedicaid