Provider Demographics
NPI:1053510651
Name:KAUFFMAN, TARA S (ARNP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:S
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-489-5730
Mailing Address - Fax:502-489-5753
Practice Address - Street 1:3900 KRESGE WAY
Practice Address - Street 2:SUITE 60
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4660
Practice Address - Country:US
Practice Address - Phone:502-893-7710
Practice Address - Fax:502-893-1884
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44683363L00000X
KY3005457363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100146890Medicaid
KYP00992184OtherRR MEDICARE KY
KY000057080UOtherHUMANA - NCVA
KY000000525603OtherANTHEM PIN
KY000000693050OtherANTHEM - NCVA
KY122021OtherSIHO - NCVA
KY000000693050OtherANTHEM - NCVA
KSP400032951Medicare PIN