Provider Demographics
NPI:1326201914
Name:KERSEY-BARRETT, TARA LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:LYNN
Last Name:KERSEY-BARRETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:TARA
Other - Middle Name:LYNN
Other - Last Name:KERSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:38 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2480
Mailing Address - Country:US
Mailing Address - Phone:419-660-2980
Mailing Address - Fax:419-660-2985
Practice Address - Street 1:38 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2480
Practice Address - Country:US
Practice Address - Phone:419-660-2980
Practice Address - Fax:419-660-2985
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH34010040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program