Provider Demographics
NPI:1467255125
Name:STARKS, TASHA
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:STARKS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:
Other - Last Name:SUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA/CMA, BA
Mailing Address - Street 1:202 W AVENUE C
Mailing Address - Street 2:
Mailing Address - City:CULLISON
Mailing Address - State:KS
Mailing Address - Zip Code:67124-7735
Mailing Address - Country:US
Mailing Address - Phone:620-388-4877
Mailing Address - Fax:
Practice Address - Street 1:202 W AVENUE C
Practice Address - Street 2:
Practice Address - City:CULLISON
Practice Address - State:KS
Practice Address - Zip Code:67124-7735
Practice Address - Country:US
Practice Address - Phone:620-388-4877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS211965376K00000X
106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No376K00000XNursing Service Related ProvidersNurse's Aide