Healthcare Provider Details

I. General information

NPI: 1841104387
Provider Name (Legal Business Name): TARA KATHLEEN HUSSONG LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2146 FERGUSON RD
CINCINNATI OH
45238-3720
US

IV. Provider business mailing address

2651 BURNET AVE
CINCINNATI OH
45219-2551
US

V. Phone/Fax

Practice location:
  • Phone: 513-362-9449
  • Fax:
Mailing address:
  • Phone: 513-362-9449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.160294.MEDS-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: