Provider Demographics
NPI:1700303518
Name:LOCKE, TARA (FNP-C)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:LOCKE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:TEDDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:338 1ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-2402
Mailing Address - Country:US
Mailing Address - Phone:828-632-9704
Mailing Address - Fax:
Practice Address - Street 1:464 HERNDON PKWY STE 216
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5200
Practice Address - Country:US
Practice Address - Phone:866-306-2026
Practice Address - Fax:833-228-5591
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009810363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAMT8002785OtherDEA NUMBER