Provider Demographics
NPI:1508096363
Name:STOKES, TARA LYNN (CNM)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:LYNN
Last Name:STOKES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1887
Mailing Address - Street 2:ELKHART GENERAL PHYSICIAN SERVICES
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46515-1887
Mailing Address - Country:US
Mailing Address - Phone:574-389-0542
Mailing Address - Fax:574-522-8505
Practice Address - Street 1:1215 LAWN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2450
Practice Address - Country:US
Practice Address - Phone:574-293-2893
Practice Address - Fax:574-293-1298
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28138289A163W00000X
IN72000067A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN72000067BOtherCSR
IN200353990OtherMEDICAID
IN000000622176OtherANTHEM
IN72000067BOtherCSR