Individual
TABITHA DENISE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CST, CSFA
Contact information
Practice address
913 N DIXIE AVE, ELIZABETHTOWN, KY 42701-2503
(270) 706-1212
Mailing address
122 APACHE TRCE, FALLS OF ROUGH, KY 40119-6613
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
—
Other
Enumeration date
05/26/2026
Last updated
05/26/2026
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