Provider Demographics
NPI:1437178589
Name:PRICE, TARA S (NP)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:S
Last Name:PRICE
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 1268
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39649-1268
Mailing Address - Country:US
Mailing Address - Phone:601-684-2300
Mailing Address - Fax:601-684-2360
Practice Address - Street 1:1318 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2830
Practice Address - Country:US
Practice Address - Phone:601-684-2300
Practice Address - Fax:601-684-2360
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR863839363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04178340Medicaid
MS302I507328Medicare Oscar/Certification