Healthcare Provider Details

I. General information

NPI: 1669000840
Provider Name (Legal Business Name): TEKEYLA WARFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 N VAN BUREN ST
WEINER AR
72479-9289
US

IV. Provider business mailing address

9435 LACEE LN
OLIVE BRANCH MS
38654-3791
US

V. Phone/Fax

Practice location:
  • Phone: 870-605-0014
  • Fax:
Mailing address:
  • Phone: 662-544-0006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPN0000027001
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number124440
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: