Provider Demographics
NPI:1114683810
Name:CUNNINGHAM, TARA B (APRN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:B
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-1852
Mailing Address - Country:US
Mailing Address - Phone:207-350-2626
Mailing Address - Fax:
Practice Address - Street 1:1100 NW SOUTH OUTER RD STE 200
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-3069
Practice Address - Country:US
Practice Address - Phone:888-256-3814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80585-111363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner