Individual
TARA NAOMI JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1137 INDEPENDENCE DR, WEST PLAINS, MO 65775-4221
(417) 255-8464
Mailing address
1137 INDEPENDENCE DR, WEST PLAINS, MO 65775-4221
(417) 255-8464
(405) 231-3037
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2021028685
MO
Other
Enumeration date
05/08/2018
Last updated
08/04/2021
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