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:540-332-5168
Mailing Address - Fax:540-332-5875
Practice Address - Street 1:1 GREEN HILLS DR
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:VA
Practice Address - Zip Code:24482-2654
Practice Address - Country:US
Practice Address - Phone:540-245-7425
Practice Address - Fax:540-245-7430
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058338363A00000X
VA0110006256363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant