Healthcare Provider Details

I. General information

NPI: 1750190575
Provider Name (Legal Business Name): TANISHA PRYOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2262 BLUE STONE HILLS DR
HARRISONBURG VA
22801-5434
US

IV. Provider business mailing address

2262 BLUE STONE HILLS DR
HARRISONBURG VA
22801-5434
US

V. Phone/Fax

Practice location:
  • Phone: 434-409-6463
  • Fax:
Mailing address:
  • Phone: 571-831-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024192929
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001243691
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: