Individual
MRS. TARA UNDERWOOD MUDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, APRN, NP-C
Contact information
Practice address
6420 DUTCHMANS PKWY, HEART RHYTHM CENTER, LOUISVILLE, KY 40205-3372
(502) 891-8400
(502) 891-8401
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3007194
KY
363LA2200X
Adult Health Nurse Practitioner
3007194
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000747133
ANTHEM - CTS/NCVA
KY
01
—
131915
SIHO-CTS/NCVA
KY
01
—
201065430
MEDICAID - NCVA
IN
01
—
50036576
PASSPORT - NCVA
KY
05
—
7100192180
—
KY
Enumeration date
11/14/2011
Last updated
07/28/2016
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