Provider Demographics
NPI:1902218548
Name:TALIAFERRO, TABATHYA (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:TABATHYA
Middle Name:
Last Name:TALIAFERRO
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 14TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1828
Mailing Address - Country:US
Mailing Address - Phone:580-223-0447
Mailing Address - Fax:580-223-2989
Practice Address - Street 1:12101 N MACARTHUR BLVD STE 280
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-1800
Practice Address - Country:US
Practice Address - Phone:405-294-4243
Practice Address - Fax:405-294-4127
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0092913363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKR0092913OtherSTATE LICENSE