Tabathya Lane Aprn

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

TABATHYA LANE APRN

Doing business as

Evergrace Health and Wellness

Practice address

9118 Buckaloo Bend Rd
Kingston, OK 73439-2021

Phone

(580) 504-3090

NPI assigned

Jul 23, 2024

Organization subpart

No

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

Authorized official

Name

Tabathya Starr TaliaferroNPI 1902218548

Title

Sole Owner

Phone

(580) 504-3090

Specialties & licenses 2

Addresses

Other names 1

• EVERGRACE HEALTH AND WELLNESS Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tabathya Taliaferro, APRN-CNP

  • Family Nurse Practitioner
  • Oklahoma City, OK
  • NPI 1902218548
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1721692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753920000000",
    "number": "1528896396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9118 BUCKALOO BEND RD",
            "city": "KINGSTON",
            "state": "OK",
            "postal_code": "734392021",
            "telephone_number": "580-504-3090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9118 BUCKALOO BEND RD",
            "city": "KINGSTON",
            "state": "OK",
            "postal_code": "734392021",
            "telephone_number": "580-504-3090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TABATHYA LANE APRN",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-23",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "status": "A",
        "authorized_official_last_name": "TALIAFERRO",
        "authorized_official_first_name": "TABATHYA",
        "authorized_official_middle_name": "STARR",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "580-504-3090"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "364SF0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EVERGRACE HEALTH AND WELLNESS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "EVERGRACE HEALTH AND WELLNESS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Psychiatric/Mental Health Nurse Practitioner in Kingston, OK
• Providers in Kingston, OK by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.