Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 643088 | TX |
NPI | 1043599137 |
---|---|
Provider Name | Tamarah K Coffey |
First Address | Victoria, TX 77901-5469 |
Second Address | Victoria, TX 77901-3937 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2011 |
Last Update Date | 08/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
643088 | PEDIATRIC NURSE PRACTITIONER (01) | TX |