Provider Demographics
NPI:1205230851
Name:PARTON, TARA (LPN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:PARTON
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 1:85 CHESTERFIELD ST
Mailing Address - Street 2:
Mailing Address - City:KEESEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12944-1229
Mailing Address - Country:US
Mailing Address - Phone:518-420-3142
Mailing Address - Fax:
Practice Address - Street 1:85 CHESTERFIELD ST
Practice Address - Street 2:
Practice Address - City:KEESEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12944-1229
Practice Address - Country:US
Practice Address - Phone:518-420-3142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264073164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse