Provider Demographics
NPI:1932784295
Name:TARTER, PAGE J (FNP-C)
Entity Type:Individual
Prefix:
First Name:PAGE
Middle Name:J
Last Name:TARTER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17763 HIGHWAY 167
Mailing Address - Street 2:
Mailing Address - City:DRY PRONG
Mailing Address - State:LA
Mailing Address - Zip Code:71423-9205
Mailing Address - Country:US
Mailing Address - Phone:318-899-5276
Mailing Address - Fax:318-899-5932
Practice Address - Street 1:17763 HIGHWAY 167
Practice Address - Street 2:
Practice Address - City:DRY PRONG
Practice Address - State:LA
Practice Address - Zip Code:71423-9205
Practice Address - Country:US
Practice Address - Phone:318-899-5276
Practice Address - Fax:318-899-5932
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA218050363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily