Provider Demographics
NPI:1073215901
Name:JAMES, TIERRA KEONTE
Entity Type:Individual
Prefix:
First Name:TIERRA
Middle Name:KEONTE
Last Name:JAMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 PENNSYLVANIA AVE SE STE 201
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2152
Mailing Address - Country:US
Mailing Address - Phone:301-742-2205
Mailing Address - Fax:
Practice Address - Street 1:801 PENNSYLVANIA AVE SE STE 201
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2152
Practice Address - Country:US
Practice Address - Phone:301-742-2205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker