Individual
MRS. TARA RENE BLACKWELDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
224 W D. L. INGRAM AVENUE, BLDG. 1408, CANNON AFB, NM 88103-5014
(575) 784-2778
Mailing address
27TH SPECIAL OPERATIONS MEDICAL GROUP, 224 W D. L. INGRAM AVENUE, BLDG. 1408, CANNON AFB, NM 88103-5014
(575) 784-2778
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
115187
NE
Other
Enumeration date
09/27/2013
Last updated
12/11/2025
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