Provider Demographics
NPI:1093033060
Name:GUNTER, TARA GRAVES (NP)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:GRAVES
Last Name:GUNTER
Suffix:
Gender:F
Credentials:NP
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 2005
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27204-2005
Mailing Address - Country:US
Mailing Address - Phone:336-625-1172
Mailing Address - Fax:336-625-6434
Practice Address - Street 1:1207 S COX ST STE AB
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-6911
Practice Address - Country:US
Practice Address - Phone:336-625-1172
Practice Address - Fax:336-625-6434
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004718363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health