Healthcare Provider Details

I. General information

NPI: 1891217634
Provider Name (Legal Business Name): EVERLYN J TARUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13655 RIVER DR
MARYLAND HEIGHTS MO
63043-4812
US

IV. Provider business mailing address

6675 BUSINESS PKWY
ELKRIDGE MD
21075-6349
US

V. Phone/Fax

Practice location:
  • Phone: 314-592-7000
  • Fax:
Mailing address:
  • Phone: 866-799-5886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5243
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: