Provider Demographics
NPI:1043843808
Name:JASPER, TARAH WINTER (APRN PMHNP)
Entity type:Individual
Prefix:
First Name:TARAH
Middle Name:WINTER
Last Name:JASPER
Suffix:
Gender:F
Credentials:APRN PMHNP
Other - Prefix:
Other - First Name:TARAH
Other - Middle Name:WINTER
Other - Last Name:KLINEFELTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN PMHNP
Mailing Address - Street 1:4302 GRAND WOOD WAY
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-9796
Mailing Address - Country:US
Mailing Address - Phone:254-319-1121
Mailing Address - Fax:
Practice Address - Street 1:1612 DAWKINS ROAD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-8729
Practice Address - Country:US
Practice Address - Phone:502-222-0365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018541363LP0808X
NM59419363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health