Healthcare Provider Details

I. General information

NPI: 1912722851
Provider Name (Legal Business Name): TYKEONNA ARLAYZIA WASHINGTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2024
Last Update Date: 11/16/2024
Certification Date: 11/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 TIBBETS DR
BEDFORD TX
76022-6914
US

IV. Provider business mailing address

1008 ESTATES DR
KENNEDALE TX
76060-2846
US

V. Phone/Fax

Practice location:
  • Phone: 682-236-6023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number1124056
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: