Basic Information
| Provider Information | |||||||||
| NPI: | 1245348358 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALL | ||||||||
| FirstName: | TAMMY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3301 S ALAMEDA ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784111882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618572900 | ||||||||
| FaxNumber: | 3618572607 | ||||||||
| Practice Location | |||||||||
| Address1: | 3301 S ALAMEDA ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784111882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618572900 | ||||||||
| FaxNumber: | 3618572607 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA03796 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.