Provider Demographics
NPI:1417192543
Name:WILLIAMS-MATNEY, TARA (ARNP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:WILLIAMS-MATNEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:SUZETTE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:GRUNDY
Mailing Address - State:VA
Mailing Address - Zip Code:24614-1030
Mailing Address - Country:US
Mailing Address - Phone:276-935-7515
Mailing Address - Fax:276-935-4351
Practice Address - Street 1:20886 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:GRUNDY
Practice Address - State:VA
Practice Address - Zip Code:24614-9597
Practice Address - Country:US
Practice Address - Phone:276-935-7515
Practice Address - Fax:276-935-4351
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5876P363L00000X
VA0001137566363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner