Provider Demographics
NPI:1194066712
Name:ABERNATHY, TARA A (NP)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:A
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 W POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3196
Mailing Address - Country:US
Mailing Address - Phone:901-246-6955
Mailing Address - Fax:901-853-7303
Practice Address - Street 1:1164 W POPLAR AVE
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3196
Practice Address - Country:US
Practice Address - Phone:901-246-6955
Practice Address - Fax:901-853-7303
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17376363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily