Provider Demographics
NPI:1780998526
Name:ALLISON, TAMMY LOUISE (LPN)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LOUISE
Last Name:ALLISON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WHITE EAGLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601
Mailing Address - Country:US
Mailing Address - Phone:580-765-2501
Mailing Address - Fax:580-765-0984
Practice Address - Street 1:200 WHITE EAGLE DRIVE
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601
Practice Address - Country:US
Practice Address - Phone:580-765-2501
Practice Address - Fax:580-765-0984
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0057845164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700590DMedicaid
KS200614060BMedicaid
OK100700590DMedicaid