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General NPI Number Information
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NPI Number | 1154015618
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Entity Type | Individual
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Provider Name | TARA LYNN CARRICO
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Gender | Female
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Dates
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Enumeration Date | 06/07/2023
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 312 SHARON CT
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City | MIDDLETOWN
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State | OH
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Zip | 45042-4947
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Country | US
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Telephone | 513-571-7850
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Fax |
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Provider Business Mailing Address
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Address Line | 6117 PARIS BLVD N
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City | WESTERVILLE
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State | OH
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Zip | 43081-4175
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Country | US
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Telephone |
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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 | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | RN.435899
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License Number State | OH
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