Basic Information
| Provider Information | |||||||||
| NPI: | 1366861924 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TABER | ||||||||
| FirstName: | ABBEY | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | RN, APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 CREASON RD | ||||||||
| Address2: | |||||||||
| City: | CORNING | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724221716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8708573399 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | PARAGOULD | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702362000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2014 | ||||||||
| LastUpdateDate: | 12/11/2015 | ||||||||
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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 | 163W00000X | R089066 | AR | N | Nursing Service Providers | Registered Nurse | 363LF0000X | A004068 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 206993758 | 05 | AR | MEDICAID |