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General NPI Number Information
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NPI Number | 1649885443
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Entity Type | Individual
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Provider Name | TABITHA RENA YOUNG APRN
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Gender | Female
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Dates
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Enumeration Date | 09/09/2020
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Last Update Date | 10/25/2020
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Provider Practice Location Address
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Address Line | 1011 N BROADWAY ST
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City | POTEAU
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State | OK
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Zip | 74953-2609
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Country | US
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Telephone | 918-839-9699
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Fax |
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Provider Business Mailing Address
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Address Line | 107 E DORA LN
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City | POTEAU
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State | OK
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Zip | 74953-5518
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Country | US
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Telephone | 918-839-9699
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 200071
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 72781
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License Number State | OK
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