NPIMap

Individual provider Active NPI

Tabitha Dawn Pena, FNP-C

  • Family Nurse Practitioner
  • Seymour, IN
National Provider Identifier
1457722142
Registry record updated Jan 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
28180971A Issued in IN
Practice address
120 Saint Louis Ave
Seymour, IN 47274-2304
Phone
(812) 524-8388
Fax
(812) 954-5021
NPI assigned
Oct 7, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 28180971A IN Primary

Addresses

Primary practice location

120 Saint Louis Ave
Seymour, IN 47274-2304

Mailing address

8003 Castleway Dr
Indianapolis, IN 46250-1946
Phone (317) 576-1335

Other names 1

  • Ms. Tabitha Dawn Harris Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160120001552 IN Practitioner - Nurse Practitioner 9032412325 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Indiana University School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Indiana Health Centers IncGroup PAC ID 3971599473, 63 clinicians

Practice addresses (Care Compare)

120 Saint Louis Ave
Seymour, IN 47274-2304
Phone (812) 405-1857

Hospital & facility affiliations

  • Schneck Medical Center Hospital, Seymour, IN, CCN 150065

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
28180971AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Indiana Health Centers, Inc. Family Past Accepting new patients
Indiana Health Centers, Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: tabitha.pena@ihci.eclinicaldirectplus.com

Organizations & group practices 16

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.

View all 16

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1444176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674518400000",
    "number": "1457722142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8003 CASTLEWAY DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462501946",
            "telephone_number": "317-576-1335",
            "fax_number": "844-397-1311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 SAINT LOUIS AVE",
            "city": "SEYMOUR",
            "state": "IN",
            "postal_code": "472742304",
            "telephone_number": "812-524-8388",
            "fax_number": "812-954-5021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA",
        "first_name": "TABITHA",
        "middle_name": "DAWN",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-07",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "28180971A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TABITHA",
            "last_name": "HARRIS",
            "middle_name": "DAWN",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Seymour, IN

Sources for this page

Verify at the official NPI Registry.