# MRS. TARA UNDERWOOD MUDD

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1962789305
- **Gender:** F
- **Credential:** MSN, APRN, NP-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 3007194 | KY | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | 3007194 | KY | — |

## Other

- **Enumeration date:** 11/14/2011
- **Last updated:** 07/28/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000747133 | ANTHEM - CTS/NCVA | KY |
| 01 | — | 131915 | SIHO-CTS/NCVA | KY |
| 01 | — | 201065430 | MEDICAID - NCVA | IN |
| 01 | — | 50036576 | PASSPORT - NCVA | KY |
| 05 | — | 7100192180 | — | KY |