Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Tabetha Staten, NP

Individual provider Gerontology Nurse Practitioner · NPI 1104342138

Tabetha Staten, NP is a Nurse Practitioner in Green, Ohio. Qualified in 2017, 9 years ago. Practices with Illumia Health LLC, a 33-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Ohio.

Years since qualifying
9
Licensed in
OH
In the registry since
2017
What do these letters mean?
NP — Nurse Practitioner
An advanced practice nurse who can diagnose, treat and in most states prescribe.

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Practice location Address checks out

1700 Boettler Rd Ste 100
Green, OH 44685-7793
Phone: (330) 896-0009
Fax: (330) 896-0032
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Gerontology Nurse Practitioner (primary) Taxonomy 363LG0600X · Licence APRN.CNP.021511 (OH)

Record details

NPI number1104342138
Entity typeIndividual (Type 1)
GenderFemale
Credentials NP
Sole proprietorNo
NPI enumeratedAugust 22, 2017
Last updated in NPPESJuly 2, 2026
Certification dateJuly 2, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Illumia Health Llc — 33 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Colleagues at Illumia Health LLC

Clinicians the CMS Doctors & Clinicians file lists under the same group practice. CMS counts 33 clinicians in the practice; 12 are shown here.