Tara Ashley Holley, FNP is a medicare enrolled "Nurse Practitioner - Family" in Shady Cove, Oregon. Her current practice location is
21990 Highway 62, Shady Cove, Oregon. You can reach out to her office (for appointments etc.) via phone at
(541) 878-2022.
Tara Ashley Holley is licensed to practice in Oregon (license number 10009584) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1013630797.
Provider's Profile
| Full Name | Tara Ashley Holley |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Family |
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| Location | 21990 Highway 62, Shady Cove, Oregon |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1013630797
- Provider Enumeration Date: 09/19/2022
- Last Update Date: 08/03/2023
Medicare PECOS Information:
- PECOS PAC ID: 2860860558
- Enrollment ID: I20230710000939
Medical Identifiers
Medical identifiers for Tara Ashley Holley such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1013630797 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363LF0000X | Nurse Practitioner - Family | 50884 (Wyoming) | Secondary |
| 363LX0001X | Nurse Practitioner - Obstetrics & Gynecology | 50884 (Wyoming) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 10009584 (Oregon) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Tara Ashley Holley allows following entities to bill medicare on her behalf.
| Entity Name | Laura L. Johnson, N.p., P.c. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1447752035
PECOS PAC ID: 8729340187
Enrollment ID: O20180322001584 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Tara Ashley Holley is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Tara Ashley Holley, FNP
Po Box 508,
Shady Cove, OR 97539-0508
Ph: () - | Tara Ashley Holley, FNP
21990 Highway 62,
Shady Cove, OR 97539-9717
Ph: (541) 878-2022 |
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