Provider Demographics
NPI:1063763571
Name:MATHEWS, TARAH JO (APRN)
Entity type:Individual
Prefix:
First Name:TARAH
Middle Name:JO
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TARAH
Other - Middle Name:JO
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:130 SOUTHERN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-3223
Mailing Address - Country:US
Mailing Address - Phone:606-679-4782
Mailing Address - Fax:606-678-5296
Practice Address - Street 1:100 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-2604
Practice Address - Country:US
Practice Address - Phone:270-861-0606
Practice Address - Fax:270-629-2444
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007679363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health