Provider Demographics
NPI:1265915383
Name:LEDFORD, TARA (APRN, NP-C)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:LEDFORD
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 BARBERRY DRIVE NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312
Mailing Address - Country:US
Mailing Address - Phone:423-650-0381
Mailing Address - Fax:
Practice Address - Street 1:6145 SHALLOWFORD RD STE 102
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7808
Practice Address - Country:US
Practice Address - Phone:423-893-6890
Practice Address - Fax:423-648-1115
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24964363L00000X
TN165763163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse