Individual
TARA M TILTON I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
999 EXECUTIVE PARK BLVD, SUITE 102, KINGSPORT, TN 37660-4632
(423) 578-1518
(423) 230-6349
Mailing address
999 EXECUTIVE PARK BLVD, SUITE 102, KINGSPORT, TN 37660-4632
(423) 578-1518
(423) 230-6350
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1691
TN
363AS0400X
Surgical Physician Assistant
Primary
1691
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1512613
—
TN
01
—
3665354
MEDICARE ID
TN
Enumeration date
01/14/2009
Last updated
03/05/2010
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