Provider Demographics
NPI:1104424068
Name:BARNES-CHERRY, TARA LYNN (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:BARNES-CHERRY
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21202 OWENS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-2038
Mailing Address - Country:US
Mailing Address - Phone:779-334-0030
Mailing Address - Fax:779-334-0031
Practice Address - Street 1:400 S KENNEDY DR STE 300
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-2682
Practice Address - Country:US
Practice Address - Phone:815-935-7532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71010463A363L00000X
IL209021143363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily