MEDICARE: MS. TARA THIRY NP-C

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	80150	OK

General Provider Information

NPI Number	:	1619380995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TARA THIRY NP-C

Provider Business Mailing Address
First Line	:	8237 SW 109TH TER
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73173-7350
Country	:	US
Telephone Number	:	405-615-3570
Fax Number	:

Provider Business Practice Location Address
First Line	:	10601 S WESTERN AVE STE 120
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-6215
Country	:	US
Telephone Number	:	405-615-3570
Fax Number	:

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

Provider Enumeration Date	:	06/04/2014
Last Update Date	:	10/16/2023

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