Provider Demographics
NPI:1346654670
Name:VEACH, TARA (IECE)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:
Last Name:VEACH
Suffix:
Gender:F
Credentials:IECE
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:UNDERWOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IECE
Mailing Address - Street 1:428 N POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-1833
Mailing Address - Country:US
Mailing Address - Phone:270-403-8070
Mailing Address - Fax:
Practice Address - Street 1:175 W LOWRY LN STE 104
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3012
Practice Address - Country:US
Practice Address - Phone:502-727-8861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-14
Last Update Date:2014-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200231838174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator