Provider Demographics
NPI:1457882573
Name:BUCKLES, TARAH MARIE (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:TARAH
Middle Name:MARIE
Last Name:BUCKLES
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:TARAH
Other - Middle Name:MARIE
Other - Last Name:CHILDRESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7154 BIRKDALE DR
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-8695
Mailing Address - Country:US
Mailing Address - Phone:513-309-5757
Mailing Address - Fax:
Practice Address - Street 1:7217 CINCINNATI DAYTON RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-1547
Practice Address - Country:US
Practice Address - Phone:513-759-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020556363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily