Basic Information
| Provider Information | |||||||||
| NPI: | 1356642920 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GANT | ||||||||
| FirstName: | TAMISHA | ||||||||
| MiddleName: | LASHAY | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 30125 | ||||||||
| Address2: | |||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860036121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034446409 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8787 HALL RD | ||||||||
| Address2: | |||||||||
| City: | LAMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932411953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618453717 | ||||||||
| FaxNumber: | 6618453385 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2010 | ||||||||
| LastUpdateDate: | 03/12/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 843046 | CA | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN164853 | AZ | N | Nursing Service Providers | Registered Nurse | 363LP0808X | AP3762 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | 23139 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.