MEDICARE: TENEISHA TIPPS RN, NC-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0500X	Hemodialysis Registered Nurse	771717	TX
2	171400000X	Health & Wellness Coach	771717	TX
3	174H00000X	Health Educator	771717	TX
4	163W00000X	Registered Nurse	771717	TX

General Provider Information

NPI Number	:	1497503965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TENEISHA TIPPS RN, NC-BC

Provider Business Mailing Address
First Line	:	1535 HARLANDALE AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75216-1519
Country	:	US
Telephone Number	:	972-330-3746
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 HARLANDALE AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75216-1519
Country	:	US
Telephone Number	:	972-330-3746
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2024
Last Update Date	:	05/09/2024

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