Provider Demographics
NPI:1528896396
Name:TABATHYA LANE APRN
Entity type:Organization
Organization Name:TABATHYA LANE APRN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TABATHYA
Authorized Official - Middle Name:STARR
Authorized Official - Last Name:TALIAFERRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-504-3090
Mailing Address - Street 1:9118 BUCKALOO BEND RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73439-2021
Mailing Address - Country:US
Mailing Address - Phone:580-504-3090
Mailing Address - Fax:
Practice Address - Street 1:9118 BUCKALOO BEND RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:OK
Practice Address - Zip Code:73439-2021
Practice Address - Country:US
Practice Address - Phone:580-504-3090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty