Provider Demographics
NPI:1174814784
Name:CUNNINGHAM, TAMEKIA DANIELLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:TAMEKIA
Middle Name:DANIELLE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:FNP-C
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Mailing Address - Street 1:12125 WOODCREST EXECUTIVE DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5001
Mailing Address - Country:US
Mailing Address - Phone:314-317-0600
Mailing Address - Fax:314-317-0606
Practice Address - Street 1:5 MOBILE INFIRMARY CIR
Practice Address - Street 2:POB SUITE 308
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3513
Practice Address - Country:US
Practice Address - Phone:251-435-7223
Practice Address - Fax:251-435-7282
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2012-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL1-111504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL131831Medicaid
AL102I507886Medicare PIN