Provider Demographics
NPI:1730650771
Name:DYE, TARA (FNP-C)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:DYE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E A ST STE 104
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2211
Mailing Address - Country:US
Mailing Address - Phone:307-237-1900
Mailing Address - Fax:307-268-8514
Practice Address - Street 1:1300 E A ST STE 104
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2211
Practice Address - Country:US
Practice Address - Phone:307-237-1900
Practice Address - Fax:307-268-8514
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY28538.1829363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily