Provider Demographics
NPI:1659404713
Name:CARR, TARA P (CHP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:P
Last Name:CARR
Suffix:
Gender:F
Credentials:CHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 C ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3949
Mailing Address - Country:US
Mailing Address - Phone:907-532-2000
Mailing Address - Fax:
Practice Address - Street 1:10 AIRPORT WAY
Practice Address - Street 2:
Practice Address - City:COLD BAY
Practice Address - State:AK
Practice Address - Zip Code:99571-0294
Practice Address - Country:US
Practice Address - Phone:907-532-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCL6515Medicaid
AKCL6515Medicaid