Tara Stallings Waters

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5015721 Issued in NC

Practice address

1916 Skibo Rd Ste C6
Fayetteville, NC 28314-1500

Phone

(910) 500-6562

NPI assigned

May 16, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1652659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652659200000",
    "number": "1578200192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1916 SKIBO RD STE C6",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283141500",
            "telephone_number": "910-500-6562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1916 SKIBO RD STE C6",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283141500",
            "telephone_number": "910-500-6562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "TARA",
        "middle_name": "STALLINGS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-16",
        "last_updated": "2022-05-16",
        "certification_date": "2022-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "5015721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "N/A",
            "affiliation": "N",
            "endpointDescription": "N/A",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "N/A",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "N/A",
            "address_1": "1916 Skibo Rd Ste C6",
            "city": "Fayetteville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "283141500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Neola Washington
• Stacy Washington, RN
• Tashayla Washington, LCAS-A, LCSW-A
• Thomas Washington II, LCSWA
• Tonya Lakeshia Washington, CSFA
• Katrina Ann Watford Gamble, MA,NCC,LPC
• Amber Michelle Watkins
• Jessie Watkins
• Larry Watkins
• Latoya K Watkins, D.O.

• Family Medicine Physician in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 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.

Verify at the official NPI Registry.