Provider Demographics
NPI:1144608605
Name:SHULTS, TABITHA A (NP)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:A
Last Name:SHULTS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-450-3201
Mailing Address - Fax:812-450-3395
Practice Address - Street 1:520 MARY ST STE 340
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710
Practice Address - Country:US
Practice Address - Phone:812-450-3201
Practice Address - Fax:812-450-3395
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011812363L00000X
IN71005837A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner