Healthcare Provider Details

I. General information

NPI: 1891493037
Provider Name (Legal Business Name): TABITHA UNDERWOOD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 E MAIN ST STE 500
NEW IBERIA LA
70560-4046
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 337-374-7315
  • Fax:
Mailing address:
  • Phone: 225-765-5727
  • Fax: 337-534-8268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number229435
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number229435
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: