Provider Demographics
NPI:1629622980
Name:FELTON, TARA FERN (NP-C/CRNP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:FERN
Last Name:FELTON
Suffix:
Gender:F
Credentials:NP-C/CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 NARROW LANE PKWY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111-2654
Mailing Address - Country:US
Mailing Address - Phone:334-284-3105
Mailing Address - Fax:334-284-3107
Practice Address - Street 1:1421 NARROW LANE PKWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2654
Practice Address - Country:US
Practice Address - Phone:334-284-3105
Practice Address - Fax:334-284-3107
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-105344163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse