Individual
TARA FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
14949 N US HIGHWAY 25 E, CORBIN, KY 40701-6285
(606) 280-4212
(606) 215-3816
Mailing address
14949 N US HIGHWAY 25 E, CORBIN, KY 40701-6285
(606) 280-4212
(606) 215-3816
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1144622
KY
363L00000X
Nurse Practitioner
Primary
3016843
KY
Other
Enumeration date
10/09/2021
Last updated
03/11/2025
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