Provider Demographics
NPI:1770937260
Name:WILLINGHAM LOOMIS, TAMMY ANN
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:ANN
Last Name:WILLINGHAM LOOMIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:WILLINGHAM LOOMIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN-BC
Mailing Address - Street 1:1220 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-3202
Mailing Address - Country:US
Mailing Address - Phone:580-290-5112
Mailing Address - Fax:580-254-3136
Practice Address - Street 1:1220 7TH ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3202
Practice Address - Country:US
Practice Address - Phone:580-290-5112
Practice Address - Fax:580-254-3136
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK76722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
1548507130OtherNPI