Healthcare Provider Details

I. General information

NPI: 1467255125
Provider Name (Legal Business Name): TASHA STARKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TASHA SUTTON CNA/CMA, BA

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W AVENUE C
CULLISON KS
67124-7735
US

IV. Provider business mailing address

202 W AVENUE C
CULLISON KS
67124-7735
US

V. Phone/Fax

Practice location:
  • Phone: 620-388-4877
  • Fax:
Mailing address:
  • Phone: 620-388-4877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number211965
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: