Tara Grace Porter, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2020021125 Issued in MO

Practice address

1480 8TH St
West Plains, MO 65775-2010

Phone

(417) 926-5699

NPI assigned

Jul 14, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Physical Therapy Specialist Clinic, Inc.

  • Physical Therapist
  • West Plains, MO
  • NPI 1659312619

  Athletic Trainer

  NPD

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

{
    "created_epoch": "1594684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594684800000",
    "number": "1154939346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1480 8TH ST",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657752010",
            "telephone_number": "417-926-5699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1480 8TH ST",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657752010",
            "telephone_number": "417-926-5699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "TARA",
        "middle_name": "GRACE",
        "credential": "ATC, LAT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-14",
        "last_updated": "2020-07-14",
        "certification_date": "2020-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MO",
            "license": "2020021125",
            "primary": true
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "KY",
            "license": "AT1533",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kameron Day Piper, OD, MBA
• Knial Richard Piper, O.D.
• Betty Pirkle
• Marvin Kullen Poe, CRNA
• Mandy Polletta
• Kristy Potts
• Tiffany Poulette, PHARMD
• Preferred Family Healthcare Inc
• Bruce Edward Preston, MD
• Belinda Privett

• Athletic Trainer in West Plains, MO
• Providers in West Plains, MO by specialty
• Athletic Trainer in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2020; 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.