Tarrah Divine, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2014003646 Issued in MO

Practice address

2115 S Fremont Ave
Ste 4300
Springfield, MO 65804-2239

Phone

(417) 820-3911

Fax

(417) 820-3924

NPI assigned

Feb 6, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Tarrah Blevins Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Interoperability endpoints

• Direct secure messaging: tblevins115194@directb.mercy.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ozarks Medical Center

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1391644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502323200000",
    "number": "1154745537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2115 S FREMONT AVE",
            "address_2": "SUITE 4300",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "65804",
            "telephone_number": "417-820-3911",
            "fax_number": "417-820-3924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 S FREMONT AVE",
            "address_2": "STE 4300",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042239",
            "telephone_number": "417-820-3911",
            "fax_number": "417-820-3924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIVINE",
        "first_name": "TARRAH",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-06",
        "last_updated": "2017-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2014003646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARRAH",
            "last_name": "BLEVINS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jonathan Distaulo, PLPC
• Kristi Ditzfeld, LPC, NCC
• Divergent Behavioral Services LLC
• Kathy A Divine
• Linda Marie Divine
• Anthony R Divito, MD
• Patricia Mary Dix, M.D.
• Staci E Dixon, DO
• DLK Medicine LLC
• Rhonda Sue Dlouhy

• Family Nurse Practitioner in Springfield, MO
• Providers in Springfield, MO by specialty
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.