MRS. THERESA MCCORMACK (NPI# 1447611868) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447611868 |
| Entity Type | Individual |
| Full Name | MRS. THERESA MCCORMACK |
| Credential | PNP |
| Practice Address |
2035 Waterside Rd Suite 105 Prince George VA 23875-1265 |
| Practice Telephone | 8045200002 |
| Practice Fax Number | 8045202259 |
| Mailing Telephone | 8045200002 |
| Mailing Fax Number | 8045202259 |
| Enumeration Date | 2016-03-12 |
| Last Update Date | 2016-03-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
0024165150 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
2035 WATERSIDE RD SUITE 105 |
| City | PRINCE GEORGE |
| State | VA |
| Zip Code | 23875-1265 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235110453 | Melaney A Caldwell | Pediatrics | 2035 Waterside Rd, Suite 105, Prince George, VA 23875-1265 | 2005-11-07 |
| 1801345988 | Caldwell Pediatrics and Wellness Center | Skilled Nursing Facility | 2035 Waterside Rd, Suite 105, Prince George, VA 23875-1265 | 2016-09-29 |
| 1255565750 | Fafa Isabel Nyirenda | Pediatrics | 2035 Waterside Rd, Suite 105, Prince George, VA 23875-1265 | 2009-05-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083228902 | Lr Counseling Services, LLC | Community/Behavioral Health | 5000 Owens Way, Apt. 622, Prince George, VA 23875 | 2020-09-08 |
| 1053815423 | Yolanda Larrette Hoag | Nurse Practitioner | 4600 Puddledock Rd, Prince George, VA 23875 | 2018-03-21 |
| 1932534864 | Foundation for Care LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4301 Montreal Ave., Prince George, VA 23875 | 2013-09-11 |
| 1073889697 | Jemina M Liverman | Nurse Practitioner | 4260 Crossing Blvd, Prince George, VA 23875 | 2012-03-28 |
| 1245412717 | Prince George County Public Schools | Local Education Agency (LEA) | 6410 Courts Drive, Prince George, VA 23875 | 2007-11-27 |
| 1952330193 | Commonwealth of Virginia State Board of Health | Public Health or Welfare | 6459 Administration Dr., Prince George, VA 23875 | 2006-07-01 |
| 1598173155 | Divine Spine Chiropractic | Chiropractor | 4205 Crossings Blvd, Prince George, VA 23875 | 2014-07-28 |
| 1669632782 | Ashif K Jethava | Internal Medicine | 4720 Puddledock Rd, Suite 100b, Prince George, VA 23875 | 2008-06-12 |
| 1043873664 | Branbur Dialysis LLC | Clinic/Center | 4650 Puddledock Rd, Prince George, VA 23875-1235 | 2019-04-18 |
| 1033754874 | Jessica M Larche | Nurse Practitioner | 4600 Puddledock Rd, Prince George, VA 23875-1235 | 2019-11-15 |
| Find all providers in zip 23875 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760030118 | Meghan Elizabeth Hoskins | Nurse Practitioner | 2035 Waterside Rd # 105, Prince George, VA 23875-1265 | 2019-08-29 |
| 1477864841 | Karen Saunders | Nurse Practitioner | 4700 Puddledock Rd, Suite 300, Prince George, VA 23875-1268 | 2010-06-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144820010 | Grace Yi | Nurse Practitioner | 6737 Stone Maple Ter, Centreville, VA 20121-5750 | 2020-10-29 |
| 1407455660 | Peds First Healthcare LLC | Nurse Practitioner | 7419 Maclachlan Dr, Chesterfield, VA 23838-5345 | 2020-10-20 |
| 1669097978 | Madison Smith | Nurse Practitioner | 1220 Wythe St Apt 258, Alexandria, VA 22314-2279 | 2020-06-11 |
| 1013542349 | Juliet Brown | Nurse Practitioner | 5249 Duke St Ste 303, Alexandria, VA 22304-2907 | 2020-03-06 |
| 1285268441 | Marlene Mayweathers | Nurse Practitioner | 224d Cornwall St Nw Ste 104, Leesburg, VA 20176-2700 | 2020-02-26 |
| 1972143972 | Katelyn Hinderland | Nurse Practitioner | 500 Discovery Dr Ste 302, Chesapeake, VA 23320-3871 | 2020-01-08 |
| 1679049092 | Kellie Anne Archer | Nurse Practitioner | 7605 Forest Ave Ste 102, Henrico, VA 23229-4936 | 2018-10-24 |
| 1811471139 | Jessica Tabor Cline | Nurse Practitioner | 900a Rio East Ct, Charlottesville, VA 22901-8040 | 2018-09-21 |
| 1306329222 | Laura Elizabeth Grove | Nurse Practitioner | 1002 Amherst St Ste C, Winchester, VA 22601-3323 | 2018-09-07 |
| 1891289807 | Ashley Cadwallader Jeniec | Nurse Practitioner | 28 Blackwell Park Ln Ste 103, Warrenton, VA 20186-2686 | 2018-06-22 |
| Find all providers with the same taxonomy | ||||
| City | PRINCE GEORGE |
| Zip Code | 23875 |
Please comment or provide details below to improve the information on MRS. THERESA MCCORMACK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.