Provider Demographics
NPI:1750505095
Name:PHYFER, TAMIKA BOULWARE (PA-C)
Entity type:Individual
Prefix:
First Name:TAMIKA
Middle Name:BOULWARE
Last Name:PHYFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:595 W LAKE MEAD PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7015
Practice Address - Country:US
Practice Address - Phone:702-566-5500
Practice Address - Fax:702-558-7238
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV585363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1750505095Medicaid
NV585OtherSTATE LICENCE