=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891147328
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANIKA KAY CUSHING PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2016
-----------------------------------------------------
Last Update Date | 08/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 GREEN HILLS DR
-----------------------------------------------------
City | VERONA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24482-2654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-245-7425
-----------------------------------------------------
Fax | 540-245-7430
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 388
-----------------------------------------------------
City | FISHERSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22939-0388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-332-5168
-----------------------------------------------------
Fax | 540-332-5875
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | MA058338
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 0110006256
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------