Provider Demographics
NPI:1275966350
Name:JAINAGERKER, TARA GHANSHYAM (BS MS QMHA QMRP)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:GHANSHYAM
Last Name:JAINAGERKER
Suffix:
Gender:F
Credentials:BS MS QMHA QMRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 KOBIE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-1402
Mailing Address - Country:US
Mailing Address - Phone:702-716-6706
Mailing Address - Fax:
Practice Address - Street 1:3630 KOBIE CREEK CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-1402
Practice Address - Country:US
Practice Address - Phone:702-716-6706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator