Individual
TARAH BURCHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
225 E JACKSON AVE, JONESBORO, AR 72401-3119
(870) 932-4211
(870) 931-9141
Mailing address
505 E MATTHEWS SUITE 303, JONESBORO, AR 72401
(870) 932-4211
(870) 931-9141
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
C01531
AR
367500000X
Certified Registered Nurse Anesthetist
Primary
C001531
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
158116001
—
AR
01
—
5Y405C702
MEDICARE
AR
Enumeration date
07/25/2006
Last updated
06/26/2023
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