Individual
TARA PERDUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
913 N DIXIE AVE, ELIZABETHTOWN, KY 42701-2503
(877) 783-6257
(859) 514-5521
Mailing address
913 N DIXIE AVE, ELIZABETHTOWN, KY 42701-2503
(877) 783-6257
(859) 514-5521
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50003403
OH
363AM0700X
Medical Physician Assistant
50.003403
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0086921
—
OH
05
—
7100353530
—
KY
Enumeration date
05/11/2012
Last updated
10/12/2015
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