Provider Demographics
NPI:1114402328
Name:STAATS, TARA LYNN (NP-C)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:STAATS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 DIVISION STREET EXT
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-9390
Mailing Address - Country:US
Mailing Address - Phone:304-481-8272
Mailing Address - Fax:
Practice Address - Street 1:4 ROSEMAR CIR
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-1219
Practice Address - Country:US
Practice Address - Phone:304-865-5130
Practice Address - Fax:304-485-1519
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN70596-NP-C207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine