Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 73214 | OK |
NPI | 1013147842 |
---|---|
Provider Name | Tammy Lynn Dexter |
First Address | Ponca City, OK 74601-2039 |
Second Address | Ponca City, OK 74601-2039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2009 |
Last Update Date | 09/11/2021 |