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NPI Code Detail

MEDICARE: TARA ECKLES

MEDICARE: TARA ECKLES
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1568961662
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA ECKLES
Provider Business Mailing Address
First Line : 2133 E BERT KOUNS INDUSTRIAL LOOP
Second Line :
City : SHREVEPORT
State : LA
Zip : 71105-5314
Country : US
Telephone Number : 318-221-2828
Fax Number :
Provider Business Practice Location Address
First Line : 555 SAINT TAMMANY ST STE D
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-6064
Country : US
Telephone Number : 225-929-9738
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2018
Last Update Date : 12/02/2025

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Directions to “ TARA ECKLES ” Practice Location

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