Healthcare Provider Details

I. General information

NPI: 1497503965
Provider Name (Legal Business Name): TENEISHA TIPPS RN, NC-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 HARLANDALE AVE
DALLAS TX
75216-1519
US

IV. Provider business mailing address

1535 HARLANDALE AVE
DALLAS TX
75216-1519
US

V. Phone/Fax

Practice location:
  • Phone: 972-330-3746
  • Fax:
Mailing address:
  • Phone: 972-330-3746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License Number771717
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number771717
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number771717
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number771717
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: