Healthcare Provider Details

I. General information

NPI: 1043971161
Provider Name (Legal Business Name): TARYN NOEL OKUMA PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2022
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 LUCERNE ST
MINDEN NV
89423-4306
US

IV. Provider business mailing address

1661 LUCERNE ST
MINDEN NV
89423-4306
US

V. Phone/Fax

Practice location:
  • Phone: 775-782-0700
  • Fax: 775-782-0500
Mailing address:
  • Phone: 775-782-0700
  • Fax: 775-782-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2910
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: