Provider Demographics
NPI:1689487050
Name:UPCHURCH, TAMARA NICOLE (AGPCNP-BC)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:NICOLE
Last Name:UPCHURCH
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 COUNTY ROAD 1660
Mailing Address - Street 2:
Mailing Address - City:ALBA
Mailing Address - State:TX
Mailing Address - Zip Code:75410-5522
Mailing Address - Country:US
Mailing Address - Phone:903-497-7846
Mailing Address - Fax:
Practice Address - Street 1:303 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-2700
Practice Address - Country:US
Practice Address - Phone:972-563-1560
Practice Address - Fax:972-563-1545
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1189550363LG0600X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology