Healthcare Provider Details

I. General information

NPI: 1417448523
Provider Name (Legal Business Name): TESHERA TULL PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RANDOLPH ST
CANTON MA
02021-0317
US

IV. Provider business mailing address

1 JESSICAS WAY
ATTLEBORO MA
02703-6848
US

V. Phone/Fax

Practice location:
  • Phone: 857-247-3180
  • Fax:
Mailing address:
  • Phone: 857-247-3180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2306276
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2306276
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: