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General NPI Number Information
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NPI Number | 1063463362
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Entity Type | Individual
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Provider Name | CLARENCE DALLAS TARP CRNA
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 515 S 7TH ST
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City | MCALESTER
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State | OK
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Zip | 74501-5915
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Country | US
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Telephone | 870-918-4460
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Fax |
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Provider Business Mailing Address
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Address Line | 3206 CALIENTE CT #6184
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City | ARLINGTON
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State | TX
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Zip | 76017-2504
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Country | US
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Telephone | 870-918-4460
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | COO447
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R28256
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License Number State | AR
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