Provider Demographics
NPI:1114683810
Name:CUNNINGHAM, TARA B (APRN)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:B
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-1852
Mailing Address - Country:US
Mailing Address - Phone:207-350-2626
Mailing Address - Fax:
Practice Address - Street 1:6265 ROCK CHALK DR STE 1500
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-5232
Practice Address - Country:US
Practice Address - Phone:785-843-9125
Practice Address - Fax:785-505-5312
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80585363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner