Provider Demographics
NPI:1346974144
Name:MOOREHEAD, TABITHA (FNP)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:MOOREHEAD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 W 15TH ST STE 320
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7767
Mailing Address - Country:US
Mailing Address - Phone:972-985-8838
Mailing Address - Fax:844-292-1457
Practice Address - Street 1:3801 W 15TH ST STE 320
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7767
Practice Address - Country:US
Practice Address - Phone:972-985-8838
Practice Address - Fax:844-292-1457
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX1067926363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program