Healthcare Provider Details

I. General information

NPI: 1629320890
Provider Name (Legal Business Name): TARA HERREN APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NW 63RD ST STE 100
OKLAHOMA CITY OK
73116-8208
US

IV. Provider business mailing address

100 NW 63RD ST STE 100
OKLAHOMA CITY OK
73116-8208
US

V. Phone/Fax

Practice location:
  • Phone: 405-842-4435
  • Fax:
Mailing address:
  • Phone: 405-842-4435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number105191
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201585
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: