Provider Demographics
NPI:1477942787
Name:OWENS, TARA DIONNE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:DIONNE
Last Name:OWENS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-6324
Mailing Address - Country:US
Mailing Address - Phone:409-338-8186
Mailing Address - Fax:
Practice Address - Street 1:2950 NORTH LOOP W STE 500
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-8830
Practice Address - Country:US
Practice Address - Phone:832-786-4970
Practice Address - Fax:855-722-0157
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126753363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily