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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