Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | F1215334 | OH |
NPI | 1003276924 |
---|---|
Provider Name | Tabitha Marrie Baughman |
First Address | Mount Vernon, OH 43050-4158 |
Second Address | Mount Vernon, OH 43050-4158 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2016 |
Last Update Date | 04/03/2016 |