Individual
MRS. TAMARA RACHELLE BAVOUSETT
Active
Individual
MRS. TAMARA RACHELLE BAVOUSETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, C-PNP
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
657564
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
214730801
—
TX
Enumeration date
04/11/2007
Last updated
04/18/2022
Update your record
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