Provider Demographics
NPI:1417448689
Name:ACHARYA, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:ACHARYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 MCNAUGHTEN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-1678
Mailing Address - Country:US
Mailing Address - Phone:614-962-0907
Mailing Address - Fax:614-396-8966
Practice Address - Street 1:4646 TAMARACK BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6566
Practice Address - Country:US
Practice Address - Phone:614-396-8965
Practice Address - Fax:614-396-8966
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174380164W00000X
171M00000X
OHRN.522171163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator