Individual
TARA MICHELE NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
331 SIJEN AVE, WHITEMAN AIR FORCE BASE, MO 65305-1269
(660) 687-2188
(660) 687-2106
Mailing address
331 SIJEN AVE, WHITEMAN AFB, MO 65305-1269
(660) 687-2188
(660) 687-4414
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
15-00527
KS
363A00000X
Physician Assistant
Primary
PYA113653
MO
Other
Enumeration date
09/02/2005
Last updated
12/11/2024
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