Provider Demographics
NPI:1760254189
Name:MOTEN, TARA ALEXANDRIA (RN-BSN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:ALEXANDRIA
Last Name:MOTEN
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 ALBERTY LN
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74965-6502
Mailing Address - Country:US
Mailing Address - Phone:918-575-8912
Mailing Address - Fax:
Practice Address - Street 1:970 ALBERTY LN
Practice Address - Street 2:
Practice Address - City:WESTVILLE
Practice Address - State:OK
Practice Address - Zip Code:74965-6502
Practice Address - Country:US
Practice Address - Phone:918-575-8912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0136500163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical