Provider Demographics
NPI:1265563365
Name:WADKINS, TARA (CRNA)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:WADKINS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:611 ALCORN DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9368
Mailing Address - Country:US
Mailing Address - Phone:662-293-1440
Mailing Address - Fax:662-293-4334
Practice Address - Street 1:611 ALCORN DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9368
Practice Address - Country:US
Practice Address - Phone:662-293-1440
Practice Address - Fax:662-293-4334
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR857140367500000X
TN25215367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered