SHENANDOAH PAIN AND PALLIATIVE CARE CLINIC, LLC (NPI# 1659919017) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659919017 |
| Entity Type | Organization |
| Organization Name | SHENANDOAH PAIN AND PALLIATIVE CARE CLINIC, LLC |
| Practice Address |
173 E. Springbrook Road Unit 3 Broadway VA 22815 |
| Mailing Address |
Po Box 8310 Roanoke VA 24014-0310 |
| Practice Telephone | 5409017028 |
| Practice Fax Number | 5409012599 |
| Enumeration Date | 2019-12-17 |
| Last Update Date | 2020-01-27 |
| Authorized Official Name | TABITHA GARRISON (OWNER) |
| Authorized Official Telephone | 5409017028 |
| Authorized Official Credential | NP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
173 E. SPRINGBROOK ROAD UNIT 3 |
| City | BROADWAY |
| State | VA |
| Zip Code | 22815 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770130627 | Kathryn Walkley | Marriage & Family Therapist | 348 Louisa St, Broadway, VA 22815 | 2019-08-23 |
| 1912440116 | Life Enrichment Services, LLC | Counselor | 150 W Springbrook Rd, Broadway, VA 22815 | 2016-11-21 |
| 1205990983 | Tabitha T Garrison | Pain Medicine | 173 East Springbrook Road, Broadway, VA 22815 | 2006-12-20 |
| 1588742225 | Springbrook Family Medicine | Clinic/Center | 173 East Springbrook Rd, Broadway, VA 22815 | 2006-11-01 |
| 1891880217 | Broadway Family Practice, PC | Family Medicine | 12515 Timberway, Broadway, VA 22815 | 2006-10-03 |
| 1366550634 | Jeanne Marie Stutzman | Specialist | 223 E Springbook Rd, Broadway, VA 22815 | 2006-08-28 |
| 1750345310 | Brenda Mcgillivray Smith | Counselor | 1155 Early Dr, Broadway, VA 22815 | 2006-04-12 |
| 1699749648 | George Alexander Bentrem II | Family Medicine | 12515 Timber Way, Rt 259, Broadway, VA 22815 | 2006-02-15 |
| 1609367135 | Kathryn Vasco | Physician Assistant | 13892 Timber Way, Broadway, VA 22815 | 2018-05-21 |
| 1023477445 | Cori Pflugradt | Physician Assistant | 13892 Timber Way, Broadway, VA 22815 | 2016-02-12 |
| Find all providers in zip 22815 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306445846 | Stephanie Leann Ball | Nurse Practitioner | 655 Belfast School Rd, Cedar Bluff, VA 24609-8217 | 2020-10-24 |
| 1548867526 | Pamela Jean Scholl | Nurse Practitioner | 3704 Aquia Dr, Stafford, VA 22554-2705 | 2020-10-02 |
| 1356948483 | Dawn Aimee Fisher | Nurse Practitioner | 2187 Hunters Lodge Rd, Troy, VA 22974-4344 | 2020-10-01 |
| 1952918880 | Amesha Renee Custis | Nurse Practitioner | 2647 Jason Ave, Norfolk, VA 23509-1073 | 2020-09-24 |
| 1790390938 | Premier Healthcare Service, LLC | Nurse Practitioner | 1015 Eden Way N Ste A, Chesapeake, VA 23320-2787 | 2020-09-14 |
| 1871108233 | Ricky Brockington | Nurse Practitioner | 19124 Lakeside Dr, Courtland, VA 23837-2634 | 2020-09-12 |
| 1578178422 | Behishta Ishanzai | Nurse Practitioner | 7500 Geoint Dr, Springfield, VA 22150-7500 | 2020-09-08 |
| 1467066795 | Colleen Marie Gleason | Nurse Practitioner | 2522 S Arlington Mill Dr Apt D, Arlington, VA 22206-4033 | 2020-09-03 |
| 1639782659 | Wendy Renee Easter | Nurse Practitioner | 20720 Cross Timber Dr, Ashburn, VA 20147-4470 | 2020-08-28 |
| 1558974105 | Crystal Hermano | Nurse Practitioner | 5522 Swift Current Ct, Burke, VA 22015-1851 | 2020-08-24 |
| Find all providers with the same taxonomy | ||||
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| 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.