Provider Demographics
NPI:1689269565
Name:DUNCAN, TABITHA NICHOLE
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:NICHOLE
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 COON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CANNON
Mailing Address - State:KY
Mailing Address - Zip Code:40923-6345
Mailing Address - Country:US
Mailing Address - Phone:910-813-9941
Mailing Address - Fax:
Practice Address - Street 1:15 COON RIDGE DR
Practice Address - Street 2:
Practice Address - City:CANNON
Practice Address - State:KY
Practice Address - Zip Code:40923-6345
Practice Address - Country:US
Practice Address - Phone:910-813-9941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider