Provider Demographics
NPI:1750190575
Name:PRYOR, TANISHA
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:
Last Name:PRYOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BUTTERFIELD CT
Mailing Address - Street 2:
Mailing Address - City:ZION CROSSROADS
Mailing Address - State:VA
Mailing Address - Zip Code:22942-6988
Mailing Address - Country:US
Mailing Address - Phone:434-409-6463
Mailing Address - Fax:
Practice Address - Street 1:60 BUTTERFIELD CT
Practice Address - Street 2:
Practice Address - City:ZION CROSSROADS
Practice Address - State:VA
Practice Address - Zip Code:22942-6988
Practice Address - Country:US
Practice Address - Phone:434-409-6463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2024072022163WP0808X
VA0024192929363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health