Provider Demographics
NPI:1699482521
Name:TABITHA MCJUNKINS, PSYCHIATRIC DOCTOR OF NURSING PRACTICE P.C.
Entity type:Organization
Organization Name:TABITHA MCJUNKINS, PSYCHIATRIC DOCTOR OF NURSING PRACTICE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCJUNKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-202-4452
Mailing Address - Street 1:99 ALMADEN BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95113-1605
Mailing Address - Country:US
Mailing Address - Phone:888-597-7924
Mailing Address - Fax:
Practice Address - Street 1:99 ALMADEN BLVD STE 600
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95113-1605
Practice Address - Country:US
Practice Address - Phone:888-597-7924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty