Provider Demographics
NPI:1467505958
Name:HENDRIX, TARA (FNP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9550 HWY 412W SUITE C
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351
Mailing Address - Country:US
Mailing Address - Phone:731-968-1400
Mailing Address - Fax:731-847-1127
Practice Address - Street 1:9550 HWY 412W SUITE C
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351
Practice Address - Country:US
Practice Address - Phone:731-968-1400
Practice Address - Fax:731-847-1127
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN7201363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3903056Medicaid
TN4042004OtherBLUE CROSS
TN4042004OtherBLUE CROSS
TNP25627Medicare UPIN