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General NPI Number Information
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NPI Number | 1487346243
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Entity Type | Individual
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Provider Name | TARA FAITH UNDERWOOD APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 10/19/2023
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Provider Practice Location Address
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Address Line | 530 S JACKSON ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-1675
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Country | US
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Telephone | 502-562-4429
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Fax |
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Provider Business Mailing Address
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Address Line | 4206 BRIARWOOD RD
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City | LOUISVILLE
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State | KY
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Zip | 40207-4036
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Country | US
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Telephone | 423-413-6911
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 4003621
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 0024187025
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 0024187025
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 4003621
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License Number State | KY
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