Provider Demographics
NPI:1962846626
Name:BARNETT, TARA LORENE (LAC)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:LORENE
Last Name:BARNETT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 FORUM BLVD
Mailing Address - Street 2:SUITE B2
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6343
Mailing Address - Country:US
Mailing Address - Phone:573-228-5335
Mailing Address - Fax:
Practice Address - Street 1:2600 FORUM BLVD
Practice Address - Street 2:SUITE B2
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6343
Practice Address - Country:US
Practice Address - Phone:573-228-5335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011001343171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist