MEDICARE: MRS. TANIKA MOTLEY 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
1	1041C0700X	Clinical Social Worker		VA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024184964	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760003719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TANIKA MOTLEY PMHNP-BC

Provider Business Mailing Address
First Line	:	5300 KEMPSRIVER DR STE 114
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5369
Country	:	US
Telephone Number	:	757-354-2723
Fax Number	:	757-866-5662

Provider Business Practice Location Address
First Line	:	5300 KEMPSRIVER DR STE 114
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5369
Country	:	US
Telephone Number	:	757-354-2723
Fax Number	:	757-866-5662

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2020
Last Update Date	:	02/07/2026

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