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General NPI Number Information
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NPI Number | 1285204867
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Entity Type | Individual
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Provider Name | TARA MCCLANAHAN MARTINEZ FNP
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Gender | Female
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Dates
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Enumeration Date | 06/28/2021
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 141 HIGHWAY 402
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City | NAPOLEONVILLE
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State | LA
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Zip | 70390-2217
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Country | US
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Telephone | 985-369-6027
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Fax | 985-369-7656
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Provider Business Mailing Address
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Address Line | 141 HIGHWAY 402
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City | NAPOLEONVILLE
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State | LA
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Zip | 70390-2217
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Country | US
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Telephone | 985-369-6027
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Fax | 985-369-7656
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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 | 220766
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License Number State | LA
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