Basic Information
| Provider Information | |||||||||
| NPI: | 1609350735 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURHANNA | ||||||||
| FirstName: | TARYN | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1342 MOCKINGBIRD DR | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442406204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302561119 | ||||||||
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| Practice Location | |||||||||
| Address1: | 143 GOUGLER AVE | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306731016 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2018 | ||||||||
| LastUpdateDate: | 02/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | APRN.CNP.023219 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LP2300X | APRN.CNP.023219 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363LA2200X | APRN.CNP.023219 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.