Active NPI
Tara Lynn Nichols, CNP
- Nurse Practitioner
- Canton, OH
National Provider Identifier
1205364007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- APRN.CNP.020528
- Practice address
- 2600 6TH St SW
Canton, OH 44710-1702 - Phone
- (330) 363-1342
- NPI assigned
- May 24, 2017
- Last updated
- Nov 23, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | APRN.CNP.020528 | OH | Primary |
| Registered Nurse | 163W00000X | 365623 | OH |
Addresses
Primary practice location
2600 6TH St SW
Canton, OH 44710-1702
Mailing address
2600 6TH St SW Ste A2-800
Canton, OH 44710-1702
Phone (330) 363-1342
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205364007 | Medicaid | OH |
Other names 1
- Tara Lynn Wagner
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | tara.nichols@aultman.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 365623 | OH | MD | Registered Nurse |
| APRN.CNP.020528 | OH | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1495584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669161600000",
"number": "1205364007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2600 6TH ST SW STE A2-800",
"city": "CANTON",
"state": "OH",
"postal_code": "447101702",
"telephone_number": "330-363-1342",
"fax_number": "330-363-1361"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2600 6TH ST SW",
"city": "CANTON",
"state": "OH",
"postal_code": "447101702",
"telephone_number": "330-363-1342"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "TARA",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-05-24",
"last_updated": "2022-11-23",
"certification_date": "2022-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "OH",
"license": "APRN.CNP.020528",
"primary": true
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "OH",
"license": "365623",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1205364007",
"state": "OH"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "tara.nichols@aultman.com",
"affiliation": "N",
"endpointDescription": "work email",
"address_1": "2600 6th St SW # A2-800",
"city": "Canton",
"state": "OH",
"country_code": "US",
"postal_code": "447101702",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "TARA",
"last_name": "WAGNER",
"middle_name": "LYNN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Canton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.