Individual
TAMULA K MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3202 MILLER ST, BETHANY, MO 64424-2713
(660) 425-3154
(660) 425-6663
Mailing address
26180 E STATE HIGHWAY MM, GILMAN CITY, MO 64642-8139
(660) 425-2365
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2003006425
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2003006425
LICENSE NUMBER
MO
Enumeration date
02/01/2006
Last updated
06/03/2010
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