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General NPI Number Information
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NPI Number | 1598586943
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Entity Type | Individual
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Provider Name | TARA LYNN PEURIFOY AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 501 SAUNDERS AVE STE 320
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City | TYLER
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State | TX
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Zip | 75702-7524
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Country | US
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Telephone | 903-606-4300
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Fax | 903-606-1283
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Provider Business Mailing Address
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Address Line | 16972 LAKEWAY CIR
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City | FLINT
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State | TX
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Zip | 75762-5809
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Country | US
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Telephone | 903-283-3831
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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 | 1175479
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 877872
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License Number State | TX
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