Tilton, Tara M

Tilton, Tara M is an individual health care provider with primary practice located at 999 Executive Park Blvd Suite 102, Kingsport TN 37660-4632. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Surgical is her primary health care specialty. Tilton, Tara M can be contacted via phone (423) 578-1518.

Contact Information

Primary practice address
999 Executive Park Blvd Suite 102 Kingsport TN 37660-4632
Phone: (423) 578-1518
Fax: (423) 230-6349
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 1691 Tennessee
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 1691 Tennessee

Profile Details

NPI number 1841437761
LBN Legal business name Tilton, Tara M
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 14th, 2009
Last updated Mar 5th, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1841437761 NPPES
Tennessee Other 3665354 MEDICARE ID
Tennessee MEDICAID 1512613 MEDICARE ID

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