Provider Demographics
NPI:1821851247
Name:GREGORY, TABITHA PATRICE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:PATRICE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 FOX DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22603-8613
Mailing Address - Country:US
Mailing Address - Phone:540-546-2624
Mailing Address - Fax:
Practice Address - Street 1:878 FOX DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22603-8613
Practice Address - Country:US
Practice Address - Phone:540-546-2624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024188970363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health