MEDICARE: TARA CLARKSON

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	227800000X	Certified Respiratory Therapist	RC2080	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932521515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA CLARKSON

Provider Business Mailing Address
First Line	:	2870 S MARYLAND PKWY
Second Line	:	SUITE 230
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-5031
Country	:	US
Telephone Number	:	702-893-3333
Fax Number	:	702-893-0960

Provider Business Practice Location Address
First Line	:	2870 S MARYLAND PKWY
Second Line	:	SUITE 200
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-5031
Country	:	US
Telephone Number	:	702-380-1060
Fax Number	:	702-380-1081

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

Provider Enumeration Date	:	01/15/2014
Last Update Date	:	01/15/2014

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Directions to “ TARA CLARKSON ” Practice Location

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