Provider Demographics
NPI:1598131542
Name:LEFORCE, TABATHA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TABATHA
Middle Name:
Last Name:LEFORCE
Suffix:
Gender:F
Credentials:APRN
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 180
Mailing Address - Street 2:
Mailing Address - City:BATTIEST
Mailing Address - State:OK
Mailing Address - Zip Code:74722-0180
Mailing Address - Country:US
Mailing Address - Phone:580-241-5294
Mailing Address - Fax:580-241-5549
Practice Address - Street 1:6026 BATTIEST PICKENS RD
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:OK
Practice Address - Zip Code:74728-5033
Practice Address - Country:US
Practice Address - Phone:580-241-5294
Practice Address - Fax:580-241-5549
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK78809363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily