Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 535114 | TX |
NPI | 1124328893 |
---|---|
Provider Name | Tamara Lynn Philpott |
First Address | Josephine, TX 75164-0355 |
Second Address | Dallas, TX 75231-4426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2010 |
Last Update Date | 28/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
535114 | NURSING LICENSE (01) | TX |