MEDICARE: TARA MEREDITH APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	3014335	KY
2	363LF0000X	Family Nurse Practitioner	3014335	KY
3	208000000X	Pediatrics Physician	3014335	KY

General Provider Information

NPI Number	:	1215560677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA MEREDITH APRN

Provider Business Mailing Address
First Line	:	PO BOX 784
Second Line	:
City	:	BROWNSVILLE
State	:	KY
Zip	:	42210-0784
Country	:	US
Telephone Number	:	270-975-4050
Fax Number	:	844-374-0233

Provider Business Practice Location Address
First Line	:	210 S MAIN ST STE 101
Second Line	:
City	:	BROWNSVILLE
State	:	KY
Zip	:	42210-9001
Country	:	US
Telephone Number	:	270-975-4050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2020
Last Update Date	:	03/06/2026

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Directions to “ TARA MEREDITH APRN” Practice Location

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