Provider Demographics
NPI:1942574645
Name:NORRIS, TARA (APN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:NORRIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4704 CHESTNUT WAY
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-2312
Mailing Address - Country:US
Mailing Address - Phone:479-883-8059
Mailing Address - Fax:
Practice Address - Street 1:7217 CAMERON PARK DR
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6167
Practice Address - Country:US
Practice Address - Phone:479-831-6007
Practice Address - Fax:479-782-1242
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03653363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health