Basic Information
| Provider Information | |||||||||
| NPI: | 1639767148 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRINSON | ||||||||
| FirstName: | TAMRA | ||||||||
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| Credential: | CST,CSFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9132 ELM TREE CIR | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757037620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9032799151 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 S BECKHAM AVE | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757011908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035318890 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2021 | ||||||||
| LastUpdateDate: | 01/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZC0007X | TX | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant |
No ID Information.