Provider Demographics
NPI:1922378025
Name:SISK, TARENA JO (APRN, CNM)
Entity type:Individual
Prefix:
First Name:TARENA
Middle Name:JO
Last Name:SISK
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 ROGERS AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4034
Mailing Address - Country:US
Mailing Address - Phone:479-785-2229
Mailing Address - Fax:479-478-6745
Practice Address - Street 1:7001 ROGERS AVE STE 403
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4034
Practice Address - Country:US
Practice Address - Phone:479-785-2229
Practice Address - Fax:479-478-6745
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR233688367A00000X
TX1074958367A00000X
KS2500001367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife