Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | F0609168 | OK |
NPI | 1003045501 |
---|---|
Provider Name | Tammy Ann Harrelson |
First Address | Midwest City, OK 73110-7530 |
Second Address | Oklahoma City, OK 73134-4003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2009 |
Last Update Date | 19/06/2013 |