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NPI Code Detail

MEDICARE: MRS. MAVIS N TAH SAMA HHA, PMHNP-BC

MEDICARE: MRS. MAVIS N TAH SAMA HHA, PMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner0024191310VA

General Provider Information

NPI Number : 1073855490
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MAVIS N TAH SAMA HHA, PMHNP-BC
Provider Business Mailing Address
First Line : 9202 CENTER OAK CT
Second Line :
City : MECHANICSVILLE
State : VA
Zip : 23116-2744
Country : US
Telephone Number : 804-207-6737
Fax Number :
Provider Business Practice Location Address
First Line : 9202 CENTER OAK CT
Second Line :
City : MECHANICSVILLE
State : VA
Zip : 23116-2744
Country : US
Telephone Number : 804-207-6737
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2013
Last Update Date : 08/27/2025

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