Provider Demographics
NPI:1598528762
Name:BARRENTINE, TARA SUSAN (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:SUSAN
Last Name:BARRENTINE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22230 133RD ST E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-7574
Mailing Address - Country:US
Mailing Address - Phone:919-345-0677
Mailing Address - Fax:
Practice Address - Street 1:22230 133RD ST E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-7574
Practice Address - Country:US
Practice Address - Phone:919-345-0677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61524402363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health