Individual provider Active NPI

Tabatha Nicole Peters, FNP-C

  • Family Nurse Practitioner
  • McConnelsville, OH
National Provider Identifier
1700553641
Registry record updated Nov 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN.CNP.0029774 Issued in OH
Practice address
3322 E State Route 78 NE
McConnelsville, OH 43756-9284
Phone
(740) 962-2690
NPI assigned
Aug 27, 2021
Last updated
Nov 24, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 24, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X APRN.CNP.0029774 OH
Family Nurse Practitioner 363LF0000X APRN.CNP.0029774 OH Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APRN.CNP.0029774 OH
Primary Care Nurse Practitioner 363LP2300X APRN.CNP.0029774 OH

Addresses

Primary practice location

3322 E State Route 78 NE
McConnelsville, OH 43756-9284

Mailing address

PO Box 396
Springboro, OH 45066-0396
Phone (740) 624-9439

Other identifiers 1

IdentifierTypeStateIssuer
APRN.CNP.0029774OtherOHNURSING BOARD

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20221221002312 OH Practitioner - Nurse Practitioner 2668842311 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
APRN.CNP.0029774OHMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Intensive Care Experts Health Network LLC Multi-Specialty Current Accepting new patients
Intensive Care Experts Health Network LLC Multi-Specialty CurrentSince Nov 17, 2025 Accepting new patients
Intensive Care Experts Health Network LLC Multi-Specialty CurrentSince Nov 17, 2025 Accepting new patients
Rivertown Healthcare Partners LLC Current Accepting new patients
Panorama Healthcare LLC Multi-Specialty CurrentSince Dec 1, 2022 Accepting new patients
Klinic Medical PLLC Multi-Specialty Past Accepting new patients

Locations

701 N Federal Hwy
Ste 601
Hallandale Beach, FL 33009
Phone (954) 573-2195

957 Becks Knob Rd
Lancaster, OH 43130
Phone (740) 653-9481

1414 S Green Rd
Ste 206
South Euclid, OH 44121
Phone (216) 258-3814

Organizations & group practices 6

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

NPI Registry JSON

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

{
    "created_epoch": "1630022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763942400000",
    "number": "1700553641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 396",
            "city": "SPRINGBORO",
            "state": "OH",
            "postal_code": "450660396",
            "telephone_number": "740-624-9439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3322 E STATE ROUTE 78 NE",
            "city": "MCCONNELSVILLE",
            "state": "OH",
            "postal_code": "437569284",
            "telephone_number": "740-962-2690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERS",
        "first_name": "TABATHA",
        "middle_name": "NICOLE",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-27",
        "last_updated": "2025-11-24",
        "certification_date": "2025-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "APRN.CNP.0029774",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.0029774",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "APRN.CNP.0029774",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "OH",
            "license": "APRN.CNP.0029774",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSING BOARD",
            "identifier": "APRN.CNP.0029774",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McConnelsville, OH

Sources for this page

Verify at the official NPI Registry.