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General NPI Number Information
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NPI Number | 1497254932
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Entity Type | Individual
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Provider Name | TENISHIA KIM SANTIAGO PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/11/2018
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 1631 MIDTOWN PL STE 104-110
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City | RALEIGH
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State | NC
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Zip | 27609-1300
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Country | US
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Telephone | 363-355-2142
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Fax | 336-863-1925
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Provider Business Mailing Address
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Address Line | 1631 MIDTOWN PL STE 104-110
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City | RALEIGH
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State | NC
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Zip | 27609-1300
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Country | US
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Telephone | 336-355-2142
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Fax | 336-933-8280
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024176300
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2025015621
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ01421600
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License Number State | NJ
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