Healthcare Provider Details

I. General information

NPI: 1104424068
Provider Name (Legal Business Name): TARA LYNN BARNES-CHERRY APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 STATE HIGHWAY K
OFALLON MO
63368
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-9354
US

V. Phone/Fax

Practice location:
  • Phone: 636-980-5300
  • Fax: 636-980-5344
Mailing address:
  • Phone: 636-980-5300
  • Fax: 636-980-5344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2026015754
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209021143
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: