Provider Demographics
NPI:1003690249
Name:HULBERT, TAMEKA R (SPECIALIST)
Entity Type:Individual
Prefix:
First Name:TAMEKA
Middle Name:R
Last Name:HULBERT
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:TAMEKA
Other - Middle Name:R
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9119 BELLEHURST DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-2530
Mailing Address - Country:US
Mailing Address - Phone:901-413-7202
Mailing Address - Fax:
Practice Address - Street 1:6801 US HIGHWAY 70 STE 104
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-4764
Practice Address - Country:US
Practice Address - Phone:901-413-7202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN928361744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management