Healthcare Provider Details

I. General information

NPI: 1346455367
Provider Name (Legal Business Name): TARA MENEFEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11603 RIDGE DR
SUGAR CREEK MO
64054-1573
US

IV. Provider business mailing address

11603 RIDGE DR
SUGAR CREEK MO
64054-1573
US

V. Phone/Fax

Practice location:
  • Phone: 816-833-1069
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: