Provider Demographics
NPI:1699157081
Name:SYKES, TARA GAIL (FNP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:GAIL
Last Name:SYKES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 W BROADWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-1136
Mailing Address - Country:US
Mailing Address - Phone:573-777-5880
Mailing Address - Fax:
Practice Address - Street 1:2003 W BROADWAY
Practice Address - Street 2:STE 100
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-1100
Practice Address - Country:US
Practice Address - Phone:573-777-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR853023363LF0000X
MO2017015824363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily