Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 03485 | KY |
N | 208000000X | Pediatrician | 34.010565 | OH |
Y | 2080A0000X | Adolescent Medicine | 03485 | KY |
NPI | 1063740249 |
---|---|
Provider Name | Tara Monday |
First Address | Burlington, KY 41005-7886 |
Second Address | Florence, KY 41042-4895 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2009 |
Last Update Date | 22/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100207600 | (05) | KY |