Provider Demographics
NPI:1720526437
Name:WILLIAMS, TAMMY LYNN (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15520 S VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-9306
Mailing Address - Country:US
Mailing Address - Phone:405-642-1747
Mailing Address - Fax:405-692-4390
Practice Address - Street 1:7 N MAIN
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:OK
Practice Address - Zip Code:73439
Practice Address - Country:US
Practice Address - Phone:405-642-1747
Practice Address - Fax:405-692-4390
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0083947363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily