Provider Demographics
NPI:1508522889
Name:TARTER, LINNEA DIANE (APRN-FNP)
Entity Type:Individual
Prefix:
First Name:LINNEA
Middle Name:DIANE
Last Name:TARTER
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 STEVE DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-4601
Mailing Address - Country:US
Mailing Address - Phone:270-858-3636
Mailing Address - Fax:270-858-3660
Practice Address - Street 1:542 STEVE DR
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-4601
Practice Address - Country:US
Practice Address - Phone:270-858-3636
Practice Address - Fax:270-858-3660
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016828363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100787380Medicaid