Provider Demographics
NPI:1205043270
Name:COLLINS, TARA A (CNS)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:A
Last Name:COLLINS
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:A
Other - Last Name:KONRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNS
Mailing Address - Street 1:901 E. 104TH ST.
Mailing Address - Street 2:MAILSTOP 400N
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:816-502-7104
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4321 WASHINGTON ST
Practice Address - Street 2:SUITE 6100
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5961
Practice Address - Country:US
Practice Address - Phone:816-932-3470
Practice Address - Fax:816-932-1383
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO083657163W00000X, 163WD0400X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
P50030Medicare UPIN
MOB94B539Medicare PIN