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NPI Code Detail

MEDICARE: TARA JO RUDISILL PA-C

MEDICARE: TARA JO RUDISILL PA-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
1363A00000XPhysician Assistant0110004072VA
2363A00000XPhysician Assistant10001346AIN

General Provider Information

NPI Number : 1982971719
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA JO RUDISILL PA-C
Provider Business Mailing Address
First Line : 250 N SHADELAND AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-4959
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2605 E CREEKS EDGE DR
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47401-8368
Country : US
Telephone Number : 812-333-2663
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2011
Last Update Date : 02/25/2026

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Directions to “ TARA JO RUDISILL PA-C” Practice Location

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