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NPI Code Detail

MEDICARE: MS. TARA LYNNE JUESCHKE PA-C

MEDICARE: MS. TARA LYNNE JUESCHKE PA-C
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
1363A00000XPhysician AssistantPA272AR

General Provider Information

NPI Number : 1932263001
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TARA LYNNE JUESCHKE PA-C
Provider Business Mailing Address
First Line : 320 N CEDAR ST
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-5536
Country : US
Telephone Number : 501-280-9640
Fax Number :
Provider Business Practice Location Address
First Line : 5315 W 12TH ST
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72204-1858
Country : US
Telephone Number : 501-664-0941
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2006
Last Update Date : 07/08/2007

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