Healthcare Provider Details

I. General information

NPI: 1295602688
Provider Name (Legal Business Name): TARA FAITH ADAMS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HEARTLAND DR
BECKLEY WV
25801-2655
US

IV. Provider business mailing address

100 HEARTLAND DR
BECKLEY WV
25801-2655
US

V. Phone/Fax

Practice location:
  • Phone: 304-256-1650
  • Fax:
Mailing address:
  • Phone: 304-256-1650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024194677
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number123586
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: