Individual
MS. TARA LYRAE SWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
1502 N JEFFERSON ST, CARROLLTON, MO 64633-1948
(660) 542-9998
(660) 542-9880
Mailing address
1502 N JEFFERSON ST, ATTN: JEAN STEELE, CARROLLTON, MO 64633-1948
(660) 542-1695
(660) 542-0363
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2000162265
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
424585909
—
MO
Enumeration date
11/07/2006
Last updated
12/05/2024
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