Healthcare Provider Details

I. General information

NPI: 1063740249
Provider Name (Legal Business Name): TARA MONDAY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARA PALMER

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7370 TURFWAY RD SUITE 280
FLORENCE KY
41042-4895
US

IV. Provider business mailing address

2835 ROLLING GREEN CT
BURLINGTON KY
41005-7886
US

V. Phone/Fax

Practice location:
  • Phone: 859-212-4567
  • Fax:
Mailing address:
  • Phone: 859-380-8332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number03485
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34.010565
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number03485
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: