Individual
MRS. TAMMERA L PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
1641 S US HIGHWAY 231, CRAWFORDSVILLE, IN 47933-9421
(765) 307-7146
(833) 464-2510
Mailing address
4196 HIGHWAY 62 412 STE A, HARDY, AR 72542-8002
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10004691A
IN
363A00000X
Physician Assistant
2054
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04020954
—
CO
01
—
261227YLQP
MEDICARE PTAN
CO
Enumeration date
10/10/2006
Last updated
12/30/2024
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