Tara Michele Nelson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PYA113653 Issued in MO

Practice address

331 Sijen Ave
Whiteman Air Force Base, MO 65305-1269

Phone

(660) 687-2188

Fax

(660) 687-2106

NPI assigned

Sep 2, 2005

Last updated

Dec 11, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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

• Midwest Neuroscience PC

  • Specialist
  • Independence, MO
  • NPI 1255522009
  NPD (past)

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

{
    "created_epoch": "1125619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733875200000",
    "number": "1528052750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "331 SIJEN AVE",
            "city": "WHITEMAN AFB",
            "state": "MO",
            "postal_code": "653051269",
            "telephone_number": "660-687-2188",
            "fax_number": "660-687-4414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 SIJEN AVE",
            "city": "WHITEMAN AIR FORCE BASE",
            "state": "MO",
            "postal_code": "653051269",
            "telephone_number": "660-687-2188",
            "fax_number": "660-687-2106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "TARA",
        "middle_name": "MICHELE",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-02",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "15-00527",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "PYA113653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Heck, LCSW
• Arthur Hickson, MD
• Kathareeya Medeiros, PA-C
• Jason Allen Miller, IDMT
• Shawn Hamilton Miranda, PA-C
• Ana Cristina Padilla Aparicio, PSY.M.
• William Price, OD
• Melanie Beverely Roberts-Fuston, LCSW
• Arthur Reynold Ross Jr., PHD
• Samuel Moore Saitie, PHARMD

• Physician Assistant in Whiteman Air Force Base, MO
• Providers in Whiteman Air Force Base, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.