Provider Demographics
NPI:1295602688
Name:ADAMS, TARA FAITH (FNP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:FAITH
Last Name:ADAMS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 TANK HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-8972
Mailing Address - Country:US
Mailing Address - Phone:276-979-5390
Mailing Address - Fax:
Practice Address - Street 1:212 TANK HOLLOW RD
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-8972
Practice Address - Country:US
Practice Address - Phone:276-979-5390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024194677208D00000X
WV123586208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty