Provider Demographics
NPI:1659862654
Name:MIDKIFF, TARA MICHELLE
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:MICHELLE
Last Name:MIDKIFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 EVERETT AVE APT A
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-6379
Mailing Address - Country:US
Mailing Address - Phone:740-281-7053
Mailing Address - Fax:
Practice Address - Street 1:112 S 3RD ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5335
Practice Address - Country:US
Practice Address - Phone:740-345-6246
Practice Address - Fax:740-345-5157
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator