Provider Demographics
NPI:1609037142
Name:FARRELL, TARA BETH (BS)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:BETH
Last Name:FARRELL
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 HWY V V
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857
Mailing Address - Country:US
Mailing Address - Phone:573-888-0642
Mailing Address - Fax:573-888-8833
Practice Address - Street 1:935 HWY V V
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857
Practice Address - Country:US
Practice Address - Phone:573-888-0642
Practice Address - Fax:573-888-8833
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator