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Individual
TABATHA D LANDRUM
Active
Individual
TABATHA D LANDRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28186169A
IN
363L00000X
Nurse Practitioner
71009930A
IN
363LF0000X
Family Nurse Practitioner
Primary
71009930A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102471365
ANTHEM PTAN
IN
01
—
1700398666
ANTHEM PTAN
IN
05
—
300037047
—
IN
Enumeration date
11/01/2017
Last updated
01/06/2026
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