Priscilla Antonette Tolbert

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

2017025995 Issued in OH

Practice address

4234 Illinois Avenue
Fort Leonard Wood, MO 65473-9098

Phone

(573) 596-0522

Fax

(573) 596-5334

NPI assigned

Dec 5, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Miss Priscilla Antonette Mahadevan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776729600000",
    "number": "1205104353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4234 ILLINOIS AVENUE",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "654739098",
            "telephone_number": "573-596-0522",
            "fax_number": "573-596-5334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4234 ILLINOIS AVENUE",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "654739098",
            "telephone_number": "573-596-0522",
            "fax_number": "573-596-5334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOLBERT",
        "first_name": "PRISCILLA",
        "middle_name": "ANTONETTE",
        "name_prefix": "Miss",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-12-05",
        "last_updated": "2026-04-21",
        "certification_date": "2026-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "UT",
            "license": "6482098-4405",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "2017025995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PRISCILLA",
            "last_name": "MAHADEVAN",
            "middle_name": "ANTONETTE",
            "prefix": "MISS",
            "credential": "APNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Brady O Thompson, DDS
• Pamela Tingle
• Christine Marie Titko, MPT
• Richard Tarleton Tobias, DDS
• Kristen Anne Tobin, MD
• Laura Torres
• Monika Torres
• Juan E Toruno
• Ryan Charles Trautmann, DDS
• Elaine Marie Turner, LP

• Psychiatric/Mental Health Nurse Practitioner in Fort Leonard Wood, MO
• Providers in Fort Leonard Wood, MO by specialty
• Psychiatric/Mental Health Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.