=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922954155
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TARA M. WILLIAMS APRN, CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2026
-----------------------------------------------------
Last Update Date | 03/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 WYOMING ST
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45409-2722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-208-6800
-----------------------------------------------------
Fax | 937-208-2139
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 305 PEARHILL DR
-----------------------------------------------------
City | WEST CARROLLTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45449-1548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-301-9354
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | 0040389
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------