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General NPI Number Information
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NPI Number | 1184248908
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Entity Type | Individual
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Provider Name | TARA PERRY
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Gender | Female
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 1113 W 7TH ST
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City | AUBURN
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State | IN
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Zip | 46706-2016
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Country | US
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Telephone | 260-909-5163
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Fax |
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Provider Business Mailing Address
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Address Line | 17664 LAKOTA CT
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City | HUNTERTOWN
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State | IN
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Zip | 46748-0178
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Country | US
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Telephone | 260-909-5163
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Fax | 260-909-5164
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71015085A
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License Number State | IN
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