Provider Demographics
NPI:1326356940
Name:MCLAMB, TARA (NP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:MCLAMB
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-0250
Mailing Address - Country:US
Mailing Address - Phone:800-634-0201
Mailing Address - Fax:866-727-0896
Practice Address - Street 1:208 COX BLVD
Practice Address - Street 2:STE 102
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9414
Practice Address - Country:US
Practice Address - Phone:919-731-6018
Practice Address - Fax:919-580-7010
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC189175363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCB196AMedicare PIN