Provider Demographics
NPI:1700940327
Name:COMPTON, TINA MICHELLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MICHELLE
Last Name:COMPTON
Suffix:
Gender:F
Credentials:FNP
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 1217
Mailing Address - Street 2:
Mailing Address - City:GRUNDY
Mailing Address - State:VA
Mailing Address - Zip Code:24614
Mailing Address - Country:US
Mailing Address - Phone:276-935-2080
Mailing Address - Fax:276-935-2082
Practice Address - Street 1:RT 5
Practice Address - Street 2:BGH PROF BLDG SUITE 101
Practice Address - City:GRUNDY
Practice Address - State:VA
Practice Address - Zip Code:24614
Practice Address - Country:US
Practice Address - Phone:276-935-2080
Practice Address - Fax:276-935-2082
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024000072207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78006293Medicaid
WV7107503000Medicaid
00W297B01Medicare ID - Type Unspecified
P11189Medicare UPIN