Provider Demographics
NPI:1205249398
Name:BILLINGS, TARA LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:LYNN
Last Name:BILLINGS
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:1 CHILDRENS PL
Mailing Address - Street 2:MSC 8515-87-1200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-454-2076
Mailing Address - Fax:314-747-8953
Practice Address - Street 1:555 E TACHEVAH DR STE 2E107
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5752
Practice Address - Country:US
Practice Address - Phone:760-561-7373
Practice Address - Fax:760-327-5140
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2023-07-10
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Provider Licenses
StateLicense IDTaxonomies
WAOP61049703208000000X, 208M00000X
MO20190195702080N0001X, 2080P0204X, 208M00000X
CA20A14620208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200070391Medicaid