NPIMap

Organization Active NPI

Tabor Therapeutics LLC

  • Psychiatry Physician
  • Ardmore, OK
National Provider Identifier
1073335949
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
TABOR THERAPEUTICS LLC
Practice address
1001 15TH Ave NW
Ardmore, OK 73401-1803
Phone
(580) 798-5015
Fax
(580) 798-5018
NPI assigned
Oct 30, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Jessy Brackelin
Title
Owner
Phone
(405) 250-6639

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

1001 15TH Ave NW
Ardmore, OK 73401-1803

Mailing address

1001 15TH Ave NW
Ardmore, OK 73401-1803
Phone (580) 798-5105

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730246400000",
    "number": "1073335949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 15TH AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011803",
            "telephone_number": "580-798-5105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 15TH AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011803",
            "telephone_number": "580-798-5015",
            "fax_number": "580-798-5018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TABOR THERAPEUTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-30",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A",
        "authorized_official_last_name": "BRACKELIN",
        "authorized_official_first_name": "JESSY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-250-6639",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ardmore, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.