Healthcare Provider Details

I. General information

NPI: 1730997024
Provider Name (Legal Business Name): TAMMY JAMEESE TENNY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BEAR MOUNTAIN BLVD
ARVIN CA
93203-1345
US

IV. Provider business mailing address

565 KERN ST
SHAFTER CA
93263-2133
US

V. Phone/Fax

Practice location:
  • Phone: 661-459-1020
  • Fax:
Mailing address:
  • Phone: 661-746-4937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95029508
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: