Healthcare Provider Details

I. General information

NPI: 1619622206
Provider Name (Legal Business Name): TAMARA FARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2022
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 2ND AVE
KOTZEBUE AK
99752-0256
US

IV. Provider business mailing address

108F N READING RD # 18671721
EPHRATA PA
17522-1668
US

V. Phone/Fax

Practice location:
  • Phone: 907-442-7640
  • Fax:
Mailing address:
  • Phone: 717-219-5711
  • Fax: 717-219-5712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP020224
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: