TARA L. TACKETT (NPI# 1235585027) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1235585027 |
Entity Type | Individual |
Full Name | TARA L. TACKETT |
Other Name | TARA L. CROWDER |
Credential | APRN-CNP |
Practice Address |
400 Court St Ste 100 Charleston WV 25301 |
Mailing Address |
400 Court St Ste 100 Charleston WV 25301-1652 |
Practice Telephone | 3043476120 |
Practice Fax Number | 3043476142 |
Mailing Telephone | 3043476120 |
Mailing Fax Number | 3043476142 |
Enumeration Date | 2016-05-11 |
Last Update Date | 2020-04-10 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | APRN63856-NP-C | WV | Physician Assistants & Advanced Practice Nursing Providers |
Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
APRN63856-NP-C | WV | Physician Assistants & Advanced Practice Nursing Providers |
N | 363LF0000X |
Nurse Practitioner Specialization: Family |
63856 | WV | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
WV | GROUP MEDICARE | 9296571 | 01 |
WV | GROUP MEDICAID | 0011253000 | 01 |
Address | Telephone Number | Fax Number |
---|---|---|
1206 Hospital Dr, Hurricane, WV 255268708 | 3047575420 | 3047575421 |
3200 Maccorkle Ave Se, Charleston, WV 253041227 | 3043885432 | |
3200 Maccorkle Ave Se, 4th Fl, Charleston, WV 25304 | 3043888240 | 3043888238 |
4605 Maccorkle Ave Sw, South Charleston, WV 253091311 | 3043063053 | 3043063054 |
Street Address |
400 COURT ST STE 100 |
City | CHARLESTON |
State | WV |
Zip Code | 25301 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1346236072 | Brad L Lindsey | Anesthesiology | 400 Court St Ste 100, Charleston, WV 25301-1652 | 2005-09-27 |
1962897272 | Alyson Marie Engle | Anesthesiology | 400 Court St Ste 100, Charleston, WV 25301-1652 | 2015-04-02 |
1902243447 | Rebecca Lynne Butcher | Registered Nurse | 400 Court St Ste 100, Charleston, WV 25301-1652 | 2013-05-23 |
1831116375 | Center for Pain Relief, Inc. | Anesthesiology | 400 Court St Ste 100, Charleston, WV 25301-1652 | 2006-07-17 |
1780619742 | Christopher Konkyo Kim | Anesthesiology | 400 Court St Ste 100, Charleston, WV 25301-1652 | 2006-07-11 |
1194759092 | Carolyn Sue Poston | Physical Therapist | 400 Court St Ste 100, Charleston, WV 25301-1652 | 2006-07-10 |
1629002522 | Mindy Beth Gardner | Physical Therapist | 400 Court St Ste 100, Charleston, WV 25301-1652 | 2006-07-10 |
1861424210 | Timothy Ray Deer | Anesthesiology | 400 Court St Ste 100, Charleston, WV 25301-1652 | 2006-07-07 |
1972535367 | Wilfrido T Tolentino Jr. | Physician Assistant | 400 Court St Ste 100, Charleston, WV 25301-1652 | 2006-07-07 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1669087680 | Kerrie Rena Harris | Counselor | 16 Leon Sullivan Way Suite 300, Charleston, WV 25301 | 2020-09-15 |
1285123471 | Burgess Dental | Dentist | 405 Capitol Street, The Parlor Suite, Charleston, WV 25301 | 2018-05-03 |
1104322320 | Kara Caldwell | Psychologist | 333 Laidley St., 4'th Floor East, Charleston, WV 25301 | 2018-04-05 |
1740638022 | Christina Phalen | Pharmacy Technician | 701 Lee Street East, Charleston, WV 25301 | 2016-05-27 |
1366867079 | Brooke Powell Garnes | Speech-Language Pathologist | 1313 Quarrier Street, Suite A, Charleston, WV 25301 | 2014-03-04 |
1952648404 | Implanted Pump Management, LLC | Home Infusion | 311 Laidley St., Suite 202, Charleston, WV 25301 | 2013-01-03 |
1730435108 | Chaitanya Mishra | Internal Medicine | 501 Morris St Ste 357, Charleston, WV 25301 | 2012-08-03 |
1033477278 | James Stephen Harman | Neurological Surgery | 415 Morris St Ste 400, Charleston, WV 25301 | 2012-04-25 |
1265674329 | Howard and Howard Dental LLC | Dentist | 1321 Virginia St., Charleston, WV 25301 | 2009-04-03 |
1881856144 | Steven David Hollosi | Emergency Medicine | 501 Morris St., Charleston, WV 25301 | 2008-06-27 |
Find all providers in zip 25301 |
Taxonomy Code | 363LF0000X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Family |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1417557737 | Diondra Johnson | Nurse Practitioner | 2327 Watchtower Ln, Charleston, SC 29414-7803 | 2020-10-27 |
1427656735 | Kisha Lanece James | Nurse Practitioner | 16 Red Mulberry Way Apt 3, Charleston, WV 25306-0107 | 2020-10-09 |
1043822216 | Amber Bagwell | Nurse Practitioner | 442 King St Fl 2, Charleston, SC 29403-6230 | 2020-08-19 |
1790396273 | Amanda Jo Grant | Nurse Practitioner | 2207 Seneca Dr, Charleston, IL 61920-3836 | 2020-08-10 |
1811514961 | Isabel Margarita Lemasters | Nurse Practitioner | 3226 Moonlight Dr, Charleston, SC 29414-8052 | 2020-07-05 |
1255954566 | Christina L. White | Nurse Practitioner | 1199 Persimmon Rd, Charleston, IL 61920 | 2020-05-20 |
1770123929 | Catherine A. Woods | Nurse Practitioner | 9313 Medical Plaza Dr Ste 310, Charleston, SC 29406-9197 | 2020-01-15 |
1104464999 | Brittany D Griffith | Nurse Practitioner | 830 Pennsylvania Ave Ste 402, Charleston, WV 25302-3390 | 2019-12-12 |
1437795747 | Brigitte Britt Huttemeyer | Nurse Practitioner | 678 Castle Pinckney Dr, Charleston, SC 29412 | 2019-11-21 |
1124660774 | Dennis Robert Moore | Nurse Practitioner | 4610 Kanawha Ave Sw Ste 302, Charleston, WV 25309-1367 | 2019-10-16 |
Find all providers in CHARLESTON |
City | CHARLESTON |
Zip Code | 25301 |
Please comment or provide details below to improve the information on TARA L. TACKETT.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.