Healthcare Provider Details

I. General information

NPI: 1588744007
Provider Name (Legal Business Name): TAMEKA BUBEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8580 CINDERBED ROAD SUITE 1700
NEWINGTON VA
22122
US

IV. Provider business mailing address

1372 HARBOR PARK DR
MEMPHIS TN
38103-9031
US

V. Phone/Fax

Practice location:
  • Phone: 703-550-8145
  • Fax:
Mailing address:
  • Phone: 901-626-7757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10590
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: