Provider Demographics
NPI:1003439662
Name:SMITHERS, TABITHA TRAM (FNP-C)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:TRAM
Last Name:SMITHERS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 GLEN FOREST DR STE 106
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3768
Mailing Address - Country:US
Mailing Address - Phone:804-495-0053
Mailing Address - Fax:
Practice Address - Street 1:7200 GLEN FOREST DR STE 106
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3768
Practice Address - Country:US
Practice Address - Phone:804-495-0053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179029363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPENDINGMedicaid