Basic Information
| Provider Information | |||||||||
| NPI: | 1225532450 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STIFF | ||||||||
| FirstName: | TABITHA | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207 E SIXTH ST | ||||||||
| Address2: | |||||||||
| City: | YAZOO CITY | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391943621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014735780 | ||||||||
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| Practice Location | |||||||||
| Address1: | 123 N FRONT ST | ||||||||
| Address2: | |||||||||
| City: | WINONA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 389672239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622832505 | ||||||||
| FaxNumber: | 6018258130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2018 | ||||||||
| LastUpdateDate: | 10/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 902458 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.