Provider Demographics
NPI:1134480692
Name:HARKLESS, TARA NOEL (LPN)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:NOEL
Last Name:HARKLESS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6906 E FRONT ST
Mailing Address - Street 2:REAR
Mailing Address - City:SCIOTOVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45662-7111
Mailing Address - Country:US
Mailing Address - Phone:740-821-5819
Mailing Address - Fax:
Practice Address - Street 1:6906 E FRONT ST
Practice Address - Street 2:REAR
Practice Address - City:SCIOTOVILLE
Practice Address - State:OH
Practice Address - Zip Code:45662-7111
Practice Address - Country:US
Practice Address - Phone:740-821-5819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN112307164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPN112307OtherOHIO STATE BOARD OF NURSING