Provider Demographics
NPI:1942962287
Name:PHILLIPS BASSETT, TABITHA CHRISTINA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:CHRISTINA
Last Name:PHILLIPS BASSETT
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7152 KYLES CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37062-7342
Mailing Address - Country:US
Mailing Address - Phone:256-431-6561
Mailing Address - Fax:
Practice Address - Street 1:7152 KYLES CREEK DR
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:TN
Practice Address - Zip Code:37062-7342
Practice Address - Country:US
Practice Address - Phone:256-431-6561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN197561163WN0002X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care