Provider Demographics
NPI:1184646218
Name:BURCHAM, TARAH (CRNA)
Entity Type:Individual
Prefix:
First Name:TARAH
Middle Name:
Last Name:BURCHAM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TARAH
Other - Middle Name:
Other - Last Name:MERRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:505 E MATTHEWS SUITE 303
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401
Mailing Address - Country:US
Mailing Address - Phone:870-932-4211
Mailing Address - Fax:870-931-9141
Practice Address - Street 1:225 E JACKSON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3119
Practice Address - Country:US
Practice Address - Phone:870-932-4211
Practice Address - Fax:870-931-9141
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC01531207L00000X
ARC001531367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y405C702OtherMEDICARE
AR158116001Medicaid