Organization · Type 2 NPI

Tabathya Lane Aprn

Psychiatric/Mental Health Nurse Practitioner · Kingston, OK

NPI number 1528896396 Active

Practice location

9118 Buckaloo Bend Rd
Kingston, OK 73439-2021

Specialties and licenses

Taxonomy	Code	License
Psychiatric/Mental Health Nurse Practitioner Primary	363LP0808X	None listed
Family Health Clinical Nurse Specialist	364SF0001X	None listed

Psychiatric/Mental Health Nurse Practitioner: Definition to come...

NPI record

NPI: 1528896396
Entity type: Organization (Type 2)
Issued: Jul 23, 2024
Last updated: Jul 31, 2025
Status: Active

Other names

<unavail>
Evergrace Health and Wellness · doing business as
Evergrace Health and Wellness · doing business as

Authorized official

Tabathya Starr Taliaferro
Sole Owner
(580) 504-3090

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About NPI 1528896396

Tabathya Lane Aprn's National Provider Identifier is 1528896396, issued on Jul 23, 2024. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Kingston, OK. The record was last updated on Jul 31, 2025.