Provider Demographics
NPI:1073509162
Name:TARAS, KATHRYN G (ANP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:G
Last Name:TARAS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1991 BALSLEY RD
Mailing Address - Street 2:
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148-9714
Mailing Address - Country:US
Mailing Address - Phone:315-539-0237
Mailing Address - Fax:315-539-0940
Practice Address - Street 1:1991 BALSLEY RD
Practice Address - Street 2:
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148-9714
Practice Address - Country:US
Practice Address - Phone:315-539-0237
Practice Address - Fax:315-539-0940
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3403691363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01857758Medicaid
S59989Medicare UPIN
NY01857758Medicaid