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General NPI Number Information
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NPI Number | 1316667496
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Entity Type | Individual
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Provider Name | TARA BETH MAHEND APRN
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Gender | Female
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Dates
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Enumeration Date | 08/30/2022
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 1424 TANNER ST
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City | ROCKPORT
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State | AR
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Zip | 72104-2082
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Country | US
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Telephone | 501-332-8612
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Fax |
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Provider Business Mailing Address
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Address Line | 5125 NORTHSHORE DR
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72118-5315
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Country | US
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Telephone | 501-224-1690
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 221686
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License Number State | AR
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