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General NPI Number Information
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NPI Number | 1174081715
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Entity Type | Individual
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Provider Name | TARA JOHNSON NP
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Gender | Female
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Dates
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Enumeration Date | 03/02/2019
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Last Update Date | 02/22/2020
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Provider Practice Location Address
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Address Line | 3801 BLUE PKWY
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City | KANSAS CITY
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State | MO
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Zip | 64130-2807
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Country | US
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Telephone | 816-923-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 7100 E 134TH TER
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City | GRANDVIEW
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State | MO
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Zip | 64030-3357
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Country | US
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Telephone | 816-797-9353
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 78424
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2018032269
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License Number State | MO
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