TAMARA NICOLE VANDIVER


Address: 2427 Hwy 255 West, Brookeland, TX 75951
Phone: 4096989600

TAMARA NICOLE VANDIVER (NPI# 1871023028) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1871023028
Entity Type Individual
Full Name TAMARA NICOLE VANDIVER
Credential FNP
Practice Address 2427 Hwy 255 West
Brookeland
TX 75951
Mailing Address 10422 Dogwood Dr
Beaumont
TX 77705-8726
Practice Telephone 4096989600
Practice Fax Number 4066982800
Mailing Telephone 4096738899
Enumeration Date 2017-06-19
Last Update Date 2017-06-19
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LF0000X Nurse Practitioner
Specialization: Family
AP133604 TX Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 2427 HWY 255 WEST
City BROOKELAND
State TX
Zip Code 75951

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1841539269 Kathleen M Russell Social Worker 139 West Lamar Street, Jasper, TX 75951 2013-02-05
1750668034 Susan Irene Craft Hearing Instrument Specialist 530 S. Wheeler, Jasper, TX 75951 2011-11-14
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Taxonomy Information

Taxonomy Code 363LF0000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Family

Taxonomy Definition

Definition to come...

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Competitor

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City BROOKELAND
Zip Code 75951

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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