Provider Demographics
NPI:1215642897
Name:MCCAULEY, TARA DENISE
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:DENISE
Last Name:MCCAULEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4536 WILSONBURG RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WV
Mailing Address - Zip Code:26426-8014
Mailing Address - Country:US
Mailing Address - Phone:304-844-5273
Mailing Address - Fax:304-918-9022
Practice Address - Street 1:2869 WILSONBURG RD
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-6561
Practice Address - Country:US
Practice Address - Phone:304-969-9454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker