Tabetha Staten, NP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

APRN.CNP.021511 Issued in OH

Practice address

1700 Boettler Rd Ste 100
Green, OH 44685-7793

Phone

(330) 896-0009

Fax

(330) 896-0032

NPI assigned

Aug 22, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Illumia Health LLCGroup PAC ID 7810424306, 33 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Illumia Health LLC

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Akron, OH
  • NPI 1740024397

  OH

  Medicare reassignment Care Compare group NPD
• Illumia Health LLC

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • White Bear Lake, MN
  • NPI 1972316289
  Care Compare group NPD
• Illumia Health LLC

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Jacksonville, FL
  • NPI 1972341147
  Care Compare group
• Community Health Care Inc.

  • Family Medicine Physician
  • Canal Fulton, OH
  • NPI 1114902137
  NPD
• Heartland Home Care, LLC

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Roanoke, VA
  • NPI 1497490205
  NPD (past)
• Heartland Hospice Services, LLC

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Beltsville, MD
  • NPI 1902545270
  NPD (past)

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

{
    "created_epoch": "1503360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782950400000",
    "number": "1104342138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "944 CHERRY ST E",
            "city": "CANAL FULTON",
            "state": "OH",
            "postal_code": "446148669",
            "telephone_number": "330-896-0009",
            "fax_number": "330-896-0032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 BOETTLER RD STE 100",
            "city": "GREEN",
            "state": "OH",
            "postal_code": "446857793",
            "telephone_number": "330-896-0009",
            "fax_number": "330-896-0032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STATEN",
        "first_name": "TABETHA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-22",
        "last_updated": "2026-07-02",
        "certification_date": "2026-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OH",
            "license": "APRN.CNP.021511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dwayne Edward Seymour
• Jatinder Sharma
• Ann Renee Shumay, E.2505128
• Michelle Marie Smith, PMHNP
• Samuel Timothy Snyder, DC
• Still Human Restoration
• Summa Physicians LLC
• Summa Physicians LLC
• Haley Renee Taylor
• Alanna Monay Thomas

• All providers in Green, OH
• Gerontology Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.