Provider Demographics
NPI:1720335672
Name:TROKEY, TARAH ASHLEY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:TARAH
Middle Name:ASHLEY
Last Name:TROKEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:TARAH
Other - Middle Name:ASHLEY
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3233 E SUNSHINE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2106
Mailing Address - Country:US
Mailing Address - Phone:417-812-8149
Mailing Address - Fax:
Practice Address - Street 1:3233 E SUNSHINE ST STE 100
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2106
Practice Address - Country:US
Practice Address - Phone:417-812-8149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61000712363A00000X
MO20120185172255A2300X
ORPA186969363A00000X
MO2023008128363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer