Provider Demographics
NPI:1174102339
Name:NABORS, TRISTIAN MAINE
Entity type:Individual
Prefix:
First Name:TRISTIAN
Middle Name:MAINE
Last Name:NABORS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 N HILLSDALE DR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-1684
Mailing Address - Country:US
Mailing Address - Phone:662-266-1233
Mailing Address - Fax:
Practice Address - Street 1:2521 E MOUNTAIN VILLAGE DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7373
Practice Address - Country:US
Practice Address - Phone:907-290-3760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS907024163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health