Individual
TOMMIE GAY STANBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
610 E 24TH ST, TISHOMINGO, OK 73460-3245
(580) 371-2343
(580) 371-2451
Mailing address
610 E 24TH ST, TISHOMINGO, OK 73460-3245
(580) 371-2343
(580) 371-2451
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1655
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1655
LICENSE NUMBER PA-C
OK
05
—
200128520A
—
OK
Enumeration date
08/06/2007
Last updated
09/02/2010
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