Provider Demographics
NPI:1427272749
Name:BAVOUSETT, TAMARA RACHELLE (RN, C-PNP)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:RACHELLE
Last Name:BAVOUSETT
Suffix:
Gender:F
Credentials:RN, C-PNP
Other - Prefix:MS
Other - First Name:TAMARA
Other - Middle Name:RACHELLE
Other - Last Name:GAWLIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, APRN, CPNP-PC
Mailing Address - Street 1:5113 WAYLAND DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-5520
Mailing Address - Country:US
Mailing Address - Phone:432-332-2080
Mailing Address - Fax:866-298-7237
Practice Address - Street 1:5113 WAYLAND DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-5520
Practice Address - Country:US
Practice Address - Phone:432-528-4025
Practice Address - Fax:866-298-7237
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX657564363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX214730801Medicaid