Healthcare Provider Details

I. General information

NPI: 1255822573
Provider Name (Legal Business Name): TARA MCEACHERN NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 COLLEGE ST
BEAUMONT TX
77701-4606
US

IV. Provider business mailing address

2713 RIVER OAKS DR
PORT NECHES TX
77651-5214
US

V. Phone/Fax

Practice location:
  • Phone: 409-212-7322
  • Fax:
Mailing address:
  • Phone: 409-749-0642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP137360
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: