Doctor Name: | TARA LINVILLE |
NPI Number: | 1013994458 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 1108 |
Business Practice Address: | 501 Se Frank Phillips Blvd Suite 202 Bartlesville, OK - 740033913 |
Business Phone Number: | 9183365454 |
Business Fax Number: | 9183364449 |
Mailing Address: | 501 Se Frank Phillips Blvd, Suite 202 BARTLESVILLE |
State: | OK |
Postal Code: | 740033913 |
Phone Number: | 9183365454 |
Fax Number: | 9183364449 |
NPI Enumeration Date: | 12/28/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 1108 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |