Provider Demographics
NPI:1447611652
Name:APPLEGATE, TARA R (APRN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:R
Last Name:APPLEGATE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-8681
Mailing Address - Fax:740-353-7900
Practice Address - Street 1:90 CIC BLVD
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-8024
Practice Address - Country:US
Practice Address - Phone:934-544-8989
Practice Address - Fax:937-544-5659
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024508363L00000X
KY3010178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3010178OtherMEDICAL LICENSE
KY7100393910Medicaid
KY7100393910Medicaid
KYK200706 EXPRESSMedicare PIN
KY3010178OtherMEDICAL LICENSE
KYK200704 FRENCHBURGMedicare PIN
KYK200701 SANDY HOOKMedicare PIN
KYK200702 OWINGSVILLEMedicare PIN