Provider Demographics
NPI:1407598550
Name:SHOLAR-CONARD, TAMIEKA J (APRN)
Entity Type:Individual
Prefix:
First Name:TAMIEKA
Middle Name:J
Last Name:SHOLAR-CONARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TAMI
Other - Middle Name:
Other - Last Name:SHOLAR-CONARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:4800 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-7437
Mailing Address - Country:US
Mailing Address - Phone:901-859-6552
Mailing Address - Fax:
Practice Address - Street 1:4301 GARDEN CITY DR STE 304
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-6105
Practice Address - Country:US
Practice Address - Phone:301-235-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-10
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN174977163WP0808X
TN35312363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health