Individual
TARA BENES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
851 E 5TH ST STE 108, WASHINGTON, MO 63090-3128
(636) 861-7870
Mailing address
28 DELLA DR, FENTON, MO 63026-4924
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2022036859
MO
Other
Enumeration date
03/11/2022
Last updated
07/14/2023
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