Provider Demographics
NPI:1396457909
Name:REXROAD, TARA PARMER (RN)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:PARMER
Last Name:REXROAD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:RENEE
Other - Last Name:REXROAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:64 STATE ST
Mailing Address - Street 2:
Mailing Address - City:GASSAWAY
Mailing Address - State:WV
Mailing Address - Zip Code:26624-1132
Mailing Address - Country:US
Mailing Address - Phone:304-364-1063
Mailing Address - Fax:304-364-8637
Practice Address - Street 1:64 STATE ST
Practice Address - Street 2:
Practice Address - City:GASSAWAY
Practice Address - State:WV
Practice Address - Zip Code:26624-1132
Practice Address - Country:US
Practice Address - Phone:304-364-1063
Practice Address - Fax:304-364-8637
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV76092163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health