Provider Demographics
NPI:1225211998
Name:ATTREAU, TABITHA RAE (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:RAE
Last Name:ATTREAU
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 N WASHINGTON ST,
Mailing Address - Street 2:APT, SUITE, FLOOR, ETC.
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-2037
Mailing Address - Country:US
Mailing Address - Phone:316-323-0850
Mailing Address - Fax:
Practice Address - Street 1:7829 E ROCKHILL ST STE 105
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3919
Practice Address - Country:US
Practice Address - Phone:316-221-5545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5382358041363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS343229Medicaid