Provider Demographics
NPI:1912500653
Name:BURD, TABITHA LYNN
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:LYNN
Last Name:BURD
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 1:4678 DARNELL RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-3114
Mailing Address - Country:US
Mailing Address - Phone:681-529-5499
Mailing Address - Fax:
Practice Address - Street 1:4678 DARNELL RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-3114
Practice Address - Country:US
Practice Address - Phone:681-529-5499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant