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General NPI Number Information
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NPI Number | 1457866451
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Entity Type | Individual
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Provider Name | TENIKA CHIQUE MCCORKLE DNP, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/13/2017
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 129 FAYETTE ST STE 101
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City | WINSTON SALEM
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State | NC
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Zip | 27101-3637
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Country | US
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Telephone | 336-510-9930
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Fax | 336-331-3303
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Provider Business Mailing Address
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Address Line | 648 HANES MALL BLVD # 314
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City | WINSTON SALEM
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State | NC
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Zip | 27103-5670
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Country | US
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Telephone | 336-510-9930
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Fax | 336-331-3303
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | MCCO-2WLLCG
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License Number State | NC
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