Provider Demographics
NPI:1891147328
Name:CUSHING, TANIKA KAY (PA-C)
Entity Type:Individual
Prefix:
First Name:TANIKA
Middle Name:KAY
Last Name:CUSHING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-932-5162
Mailing Address - Fax:540-932-5875
Practice Address - Street 1:3881 CHURCHVILLE AVE
Practice Address - Street 2:
Practice Address - City:CHURCHVILLE
Practice Address - State:VA
Practice Address - Zip Code:24421-2525
Practice Address - Country:US
Practice Address - Phone:540-213-9260
Practice Address - Fax:540-213-9264
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110006256363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical