Basic Information
| Provider Information | |||||||||
| NPI: | 1134739386 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASH | ||||||||
| FirstName: | JACOB | ||||||||
| MiddleName: | TYREE | ||||||||
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| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 358 BEARFIELD RD | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245213986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349418091 | ||||||||
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| Practice Location | |||||||||
| Address1: | 320 FEDERAL ST | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245042306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349475967 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2020 | ||||||||
| LastUpdateDate: | 08/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 363LP0808X | 0024179880 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.