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General NPI Number Information
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NPI Number | 1710226204
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Entity Type | Individual
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Provider Name | TARA RAE THOMPSON APRN
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Gender | Female
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Dates
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Enumeration Date | 02/04/2013
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Last Update Date | 03/12/2024
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Provider Practice Location Address
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Address Line | 1698 E MCANDREWS RD STE 400
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City | MEDFORD
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State | OR
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Zip | 97504-5590
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Country | US
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Telephone | 541-732-7400
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Fax | 541-732-3410
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Provider Business Mailing Address
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Address Line | 1698 E MCANDREWS RD STE 400
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City | MEDFORD
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State | OR
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Zip | 97504-5590
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Country | US
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Telephone | 541-732-7400
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Fax | 541-732-3410
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | AP 07195
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | AP61501809
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 10018842APRN-NP
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License Number State | OR
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