MEDICARE: TARA BETH HENRY ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1100	AK

General Provider Information

NPI Number	:	1326375452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA BETH HENRY ANP

Provider Business Mailing Address
First Line	:	16372 SANDPIPER DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99516-5053
Country	:	US
Telephone Number	:	907-227-6654
Fax Number	:	907-336-7862

Provider Business Practice Location Address
First Line	:	16372 SANDPIPER DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99516-5053
Country	:	US
Telephone Number	:	907-227-6654
Fax Number	:	907-336-7862

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2009
Last Update Date	:	11/10/2009

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