Tara Kim Fairbanks, CAP - 207

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

207 Issued in WY

Practice address

1430 Wilkins Cir
Casper, WY 82601-1336

Phone

(307) 237-9588

NPI assigned

Oct 3, 2024

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

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

{
    "created_epoch": "1727913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1780402115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2424 E 9TH ST",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826092838",
            "telephone_number": "307-267-7253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 WILKINS CIR",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826011336",
            "telephone_number": "307-237-9588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRBANKS",
        "first_name": "TARA",
        "middle_name": "KIM",
        "credential": "CAP - 207",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-03",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WY",
            "license": "207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashleigh Laine Evans
• Elizabeth A Eveland, R.N.
• Eye Institute of Wyoming
• Eyemart Express LLC
• Elie Fahed, M.D.
• Faith Love & Care Services
• Travis Fallgren
• Family Clinic
• Family Health Care PC
• Family of God Church

• All providers in Casper, WY
• Addiction (Substance Use Disorder) Counselor in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; 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.