Healthcare Provider Details

I. General information

NPI: 1386572089
Provider Name (Legal Business Name): TARYN BACKUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 WESTON PKWY
CARY NC
27513-2424
US

IV. Provider business mailing address

12220 PENROSE TRL
RALEIGH NC
27614-6804
US

V. Phone/Fax

Practice location:
  • Phone: 984-523-3377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number239049
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: