Individual
TARA DENISE PRIDGETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
04-28519
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
058735
BLUE CROSS BLUE SHIELD
KS
05
—
100370990A
—
KS
01
—
337170
FIRSTGUARD
KS
Enumeration date
08/12/2006
Last updated
07/08/2007
Update your record
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