Healthcare Provider Details

I. General information

NPI: 1104749258
Provider Name (Legal Business Name): TAMEKA MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMEKA CLAYBORN

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 ILLINOIS AVE
LANCASTER TX
75134-4633
US

IV. Provider business mailing address

1432 ILLINOIS AVE
LANCASTER TX
75134-4633
US

V. Phone/Fax

Practice location:
  • Phone: 214-489-7536
  • Fax:
Mailing address:
  • Phone: 214-489-7536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: