Provider Demographics
NPI:1154936607
Name:POWELL, TARA LYNN (DNP, APRN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:POWELL
Suffix:
Gender:F
Credentials:DNP, APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E PINE ST
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-3419
Mailing Address - Country:US
Mailing Address - Phone:785-443-3284
Mailing Address - Fax:
Practice Address - Street 1:212 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:KS
Practice Address - Zip Code:67748-1220
Practice Address - Country:US
Practice Address - Phone:785-672-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-79180-032363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics