Tara Clanton
Individual provider Active NPI Registered Nurse · Quitman, TX
NPI 1225655434 · NPPES record last updated Jul 3, 2020
Key facts
- NPI
- 1225655434
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 832158 (TX)
- Practice address
- 604 Christopher St
Quitman, TX 75783-1648 - Phone
- (903) 738-8505
- NPI assigned
- Jul 3, 2020
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 832158 | TX | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 832158 | TX | Yes |
Addresses
Primary practice location
604 Christopher St
Quitman, TX 75783-1648
Mailing address
604 Christopher St
Quitman, TX 75783-1648
Phone (903) 738-8505
Other providers in Quitman, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.