Provider Demographics
NPI:1528383338
Name:CHETTIAR, TARA NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:NICOLE
Last Name:CHETTIAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:NICOLE
Other - Last Name:CONNEALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 E. 104TH ST.
Mailing Address - Street 2:MAILSTOP 400N
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-9712
Mailing Address - Country:US
Mailing Address - Phone:816-502-7104
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:12330 METCALF AVE STE 420
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1307
Practice Address - Country:US
Practice Address - Phone:913-323-9000
Practice Address - Fax:913-323-9001
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0437426207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology