MEDICARE: JESSICA TARTER DVM

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	174M00000X	Veterinarian	7930	NC

General Provider Information

NPI Number	:	1578970489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA TARTER DVM

Provider Business Mailing Address
First Line	:	10009 SIX FORKS ROAD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615
Country	:	US
Telephone Number	:	919-848-1926
Fax Number	:

Provider Business Practice Location Address
First Line	:	10009 SIX FORKS RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-1636
Country	:	US
Telephone Number	:	919-848-1926
Fax Number	:

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

Provider Enumeration Date	:	07/14/2014
Last Update Date	:	07/14/2014

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