1144608605 NPI number — TABITHA A SHULTS NP

Table of content: TABITHA A SHULTS NP (NPI 1144608605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144608605 NPI number — TABITHA A SHULTS NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHULTS
Provider First Name:
TABITHA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144608605
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1510
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47706-1510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-450-3201
Provider Business Mailing Address Fax Number:
812-450-3395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 MARY ST STE 340
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-450-3201
Provider Business Practice Location Address Fax Number:
812-450-3395
Provider Enumeration Date:
05/15/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  3011812 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 71005837A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)