Healthcare Provider Details

I. General information

NPI: 1205249398
Provider Name (Legal Business Name): TARA LYNN BILLINGS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E TACHEVAH DR STE 2E107
PALM SPRINGS CA
92262-5752
US

IV. Provider business mailing address

1 CHILDRENS PL MSC 8515-87-1200
SAINT LOUIS MO
63110-1002
US

V. Phone/Fax

Practice location:
  • Phone: 760-561-7373
  • Fax: 760-327-5140
Mailing address:
  • Phone: 314-454-2076
  • Fax: 314-747-8953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOP61049703
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number2019019570
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number2019019570
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOP61049703
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2019019570
License Number StateMO
# 6
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A14620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: