Provider Demographics
NPI:1841749835
Name:DE VERE, TAMARA SUZANNE (FNP)
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:SUZANNE
Last Name:DE VERE
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:2153 S STAGECOACH DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-6702
Mailing Address - Country:US
Mailing Address - Phone:816-588-2045
Mailing Address - Fax:
Practice Address - Street 1:21 CORPORATE WOODS, 10870 BENSON DRIVE #2160
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210
Practice Address - Country:US
Practice Address - Phone:833-357-3227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-02
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS53-77413-011363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner