Healthcare Provider Details

I. General information

NPI: 1174814784
Provider Name (Legal Business Name): TAMEKIA DANIELLE CUNNINGHAM FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MOBILE INFIRMARY CIR POB SUITE 308
MOBILE AL
36607-3513
US

IV. Provider business mailing address

12125 WOODCREST EXECUTIVE DR SUITE 220
SAINT LOUIS MO
63141-5001
US

V. Phone/Fax

Practice location:
  • Phone: 251-435-7223
  • Fax: 251-435-7282
Mailing address:
  • Phone: 314-317-0600
  • Fax: 314-317-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-111504
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: