Healthcare Provider Details

I. General information

NPI: 1629960422
Provider Name (Legal Business Name): TENIKA GEORGE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TENIKA GEORGE FNP

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 RIVER OAKS DR STE B103
FLOWOOD MS
39232-7602
US

IV. Provider business mailing address

1080 RIVER OAKS DR STE B103
FLOWOOD MS
39232-7602
US

V. Phone/Fax

Practice location:
  • Phone: 601-210-3210
  • Fax: 601-210-3210
Mailing address:
  • Phone: 601-210-3210
  • Fax: 601-210-3210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAA-NP004240
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number333145
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1217891
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number907605
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: