Provider Demographics
NPI:1790336238
Name:COMPTON, TARA (RN, BSN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:COMPTON
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 1:7105B AVALANCHE AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-1381
Mailing Address - Country:US
Mailing Address - Phone:509-823-6235
Mailing Address - Fax:
Practice Address - Street 1:7105B AVALANCHE AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-1381
Practice Address - Country:US
Practice Address - Phone:509-823-6235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA643519163W00000X
OR200340915163W00000X
WA00159233163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse