Provider Demographics
NPI:1346758315
Name:ESTES, TABATHA (CSFA)
Entity Type:Individual
Prefix:
First Name:TABATHA
Middle Name:
Last Name:ESTES
Suffix:
Gender:F
Credentials:CSFA
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 2480
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76097-2480
Mailing Address - Country:US
Mailing Address - Phone:817-615-7671
Mailing Address - Fax:
Practice Address - Street 1:1243 FOXGLOVE LN
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-2734
Practice Address - Country:US
Practice Address - Phone:817-615-7671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical