Healthcare Provider Details

I. General information

NPI: 1518802420
Provider Name (Legal Business Name): TARA C. BROUSE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 WALTER REED RD STE 202
FAYETTEVILLE NC
28304-4451
US

IV. Provider business mailing address

764 WALNUT KNOLL LN
CORDOVA TN
38018-3113
US

V. Phone/Fax

Practice location:
  • Phone: 910-504-3506
  • Fax: 910-504-3507
Mailing address:
  • Phone: 901-756-5565
  • Fax: 901-756-5564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5024790
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: