Provider Demographics
NPI:1073842134
Name:BARNES, TARA C (APRN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:C
Last Name:BARNES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:R
Other - Last Name:CLAVIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:POST OFFICE BOX 1786
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70602-1786
Mailing Address - Country:US
Mailing Address - Phone:337-478-9653
Mailing Address - Fax:337-474-0988
Practice Address - Street 1:1614 WOLF CIR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-2348
Practice Address - Country:US
Practice Address - Phone:337-478-9653
Practice Address - Fax:337-474-0988
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05960363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health