Basic Information
Provider Information | |||||||||
NPI: | 1376068460 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NAVE | ||||||||
FirstName: | TABITHA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | APRN-CNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ROBBINS | ||||||||
OtherFirstName: | TABITHA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RN | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 610 E 24TH ST | ||||||||
Address2: |   | ||||||||
City: | TISHOMINGO | ||||||||
State: | OK | ||||||||
PostalCode: | 734603245 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5803712343 | ||||||||
FaxNumber: | 5803713614 | ||||||||
Practice Location | |||||||||
Address1: | 107 E POST AVE | ||||||||
Address2: |   | ||||||||
City: | COALGATE | ||||||||
State: | OK | ||||||||
PostalCode: | 745383004 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5809272828 | ||||||||
FaxNumber: | 5809279876 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/09/2017 | ||||||||
LastUpdateDate: | 10/31/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/28/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 88973 | OK | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.