Individual provider Active NPI

Tabathya Taliaferro, APRN-CNP

  • Family Nurse Practitioner
  • Oklahoma City, OK
National Provider Identifier
1902218548
Registry record updated Jul 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R0092913 Issued in OK
Practice address
12101 N Macarthur Blvd Ste 280
Oklahoma City, OK 73162-1800
Phone
(405) 294-4243
Fax
(405) 294-4127
NPI assigned
Jun 2, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2025

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 R0092913 OK Primary

Addresses

Primary practice location

12101 N Macarthur Blvd Ste 280
Oklahoma City, OK 73162-1800

Mailing address

1011 14TH Ave NW
Ardmore, OK 73401-1828
Phone (580) 223-0447

Other identifiers 1

IdentifierTypeStateIssuer
R0092913OtherOKSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20140701002316 OK Practitioner - Nurse Practitioner 4880819077 Reassigns benefits to 3 organizations
Practice locations: Kingston, OK

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Long Term Care Specialists, IncGroup PAC ID 3476550740, 37 clinicians

Practice addresses (Care Compare)

5721 NW 132ND St
Oklahoma City, OK 73142-4437
Phone (405) 557-1200

9118 Buckaloo Bend Rd
Kingston, OK 73439-2021
Phone (580) 504-3090

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R0092913OKMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Careconnectmd Oklahoma PC CurrentSince Jan 1, 2025 Accepting new patients
Tabathya Lane Aprn CurrentSince Dec 15, 2024 Accepting new patients
Long Term Care Specialists, Inc CurrentSince Jul 17, 2023 Accepting new patients
Value Based Long Term Care J PC CurrentSince May 13, 2025 Accepting new patients

Locations

3090 Bristol St
Ste 200
Costa Mesa, CA 92626
Phone (714) 992-1182

101 Park Ave
Ste 1300
Oklahoma City, OK 73102
Phone (405) 689-9820

3233 NW 10th St
Oklahoma City, OK 73107
Phone (405) 943-8366

5721 NW 132nd St
Oklahoma City, OK 73142
Phone (405) 557-1200

1415 W 15th St
Sulphur, OK 73086
Phone (580) 622-2030

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1401667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753920000000",
    "number": "1902218548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 14TH AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011828",
            "telephone_number": "580-223-0447",
            "fax_number": "580-223-2989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12101 N MACARTHUR BLVD STE 280",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731621800",
            "telephone_number": "405-294-4243",
            "fax_number": "405-294-4127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TALIAFERRO",
        "first_name": "TABATHYA",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-02",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "R0092913",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "R0092913",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.