Doctor Name: | TARA E BYROM |
NPI Number: | 1083954416 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | 2013042963 |
Business Practice Address: | 11911 S Oak St Jenks, OK - 740372667 |
Business Phone Number: | 9182960750 |
Business Fax Number: | 9189957651 |
Mailing Address: | 303 E Taft Ave, Suite 3 SAPULPA |
State: | OK |
Postal Code: | 740665651 |
Phone Number: | 9182242222 |
Fax Number: | 9182242227 |
NPI Enumeration Date: | 02/21/2013 |
NPI Last Update Date: | 01/04/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | 2013042963 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |