Healthcare Provider Details

I. General information

NPI: 1508571217
Provider Name (Legal Business Name): HEKA NURSE PRACTITIONER TELEPSYCHIATRY APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 MCKENNA DR
TURLOCK CA
95382-7315
US

IV. Provider business mailing address

3200 W MONTE VISTA AVE STE 131
TURLOCK CA
95380-8412
US

V. Phone/Fax

Practice location:
  • Phone: 218-329-7708
  • Fax: 209-340-7775
Mailing address:
  • Phone: 209-494-8584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA ELIZABETH CONTEH
Title or Position: OWNER CEO
Credential: NURSE PRACTITIONER
Phone: 209-494-8584