Healthcare Provider Details

I. General information

NPI: 1346654670
Provider Name (Legal Business Name): TARA VEACH IECE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TARA UNDERWOOD IECE

II. Dates (important events)

Enumeration Date: 06/14/2014
Last Update Date: 06/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 W LOWRY LN STE 104
LEXINGTON KY
40503-3012
US

IV. Provider business mailing address

428 N POPLAR ST
CAMPBELLSVILLE KY
42718-1833
US

V. Phone/Fax

Practice location:
  • Phone: 502-727-8861
  • Fax:
Mailing address:
  • Phone: 270-403-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number200231838
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: