Provider Demographics
NPI:1801290838
Name:KING, TARA KAYE
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:KAYE
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:KAYE
Other - Last Name:O'DONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:815 FORT ST
Mailing Address - Street 2:A
Mailing Address - City:BARLING
Mailing Address - State:AR
Mailing Address - Zip Code:72923-2164
Mailing Address - Country:US
Mailing Address - Phone:479-494-5740
Mailing Address - Fax:479-478-6213
Practice Address - Street 1:815 FORT ST
Practice Address - Street 2:A
Practice Address - City:BARLING
Practice Address - State:AR
Practice Address - Zip Code:72923-2164
Practice Address - Country:US
Practice Address - Phone:479-494-5740
Practice Address - Fax:479-478-6213
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator