Provider Demographics
NPI:1790584258
Name:MOYER, TARA JO (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:JO
Last Name:MOYER
Suffix:
Gender:
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 E FAIRFAX ST
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22611-1100
Mailing Address - Country:US
Mailing Address - Phone:814-414-6811
Mailing Address - Fax:814-414-6811
Practice Address - Street 1:318 E FAIRFAX ST
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:22611-1100
Practice Address - Country:US
Practice Address - Phone:814-414-6811
Practice Address - Fax:814-414-6811
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAL-306132174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN