Healthcare Provider Details

I. General information

NPI: 1063463362
Provider Name (Legal Business Name): CLARENCE DALLAS TARP CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CLARENCE TARP

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S 7TH ST
MCALESTER OK
74501-5915
US

IV. Provider business mailing address

3206 CALIENTE CT #6184
ARLINGTON TX
76017-2504
US

V. Phone/Fax

Practice location:
  • Phone: 870-918-4460
  • Fax:
Mailing address:
  • Phone: 870-918-4460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOO447
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR28256
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: