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Organization
TABATHYA LANE APRN
Active
Organization
TABATHYA LANE APRN
Active
Other names
EVERGRACE HEALTH AND WELLNESS
Organization subpart
No
Provider details
NPI number
Authorized official
TABATHYA STARR TALIAFERRO (SOLE OWNER)
(580) 504-3090
Entity
Organization
Contact information
Practice address
9118 BUCKALOO BEND RD, KINGSTON, OK 73439-2021
(580) 504-3090
Mailing address
9118 BUCKALOO BEND RD, KINGSTON, OK 73439-2021
(580) 504-3090
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
364SF0001X
Family Health Clinical Nurse Specialist
—
—
Other
Enumeration date
07/23/2024
Last updated
07/31/2025
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