MEDICARE: TABITHA THOMAS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	61458750	WA

General Provider Information

NPI Number	:	1225983695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TABITHA THOMAS RN

Provider Business Mailing Address
First Line	:	380 CHASE AVE
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-2924
Country	:	US
Telephone Number	:	509-897-3700
Fax Number	:	509-897-5743

Provider Business Practice Location Address
First Line	:	380 CHASE AVE
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-2924
Country	:	US
Telephone Number	:	509-897-3700
Fax Number	:	509-897-5743

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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