Provider Demographics
NPI:1578817110
Name:TAYLOR, TABITHA T (APRN)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:T
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:A
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:110 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42330-1506
Mailing Address - Country:US
Mailing Address - Phone:270-931-2059
Mailing Address - Fax:270-931-2079
Practice Address - Street 1:110 S 2ND ST
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:KY
Practice Address - Zip Code:42330-1506
Practice Address - Country:US
Practice Address - Phone:270-931-2059
Practice Address - Fax:270-931-2079
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007564363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100265510Medicaid
KYK067212Medicare PIN
KY7100265510Medicaid