Provider Demographics
NPI:1174739239
Name:WILLIAMS, TARA S (CPNP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:SHEPHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2700 PIERSALL DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-3406
Mailing Address - Country:US
Mailing Address - Phone:972-679-4777
Mailing Address - Fax:
Practice Address - Street 1:3200 SOUTHWEST FWY STE 2100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7525
Practice Address - Country:US
Practice Address - Phone:833-208-7770
Practice Address - Fax:833-464-3584
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP500014523363L00000X
FLAPRN11024750363L00000X
VA0024190458363LP0200X
OKR0069453363LP0200X
NYF383654-01363LP0200X
TXAP112022363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL119979700Medicaid
TX1174739239Medicaid