Provider Demographics
NPI:1346980943
Name:VINCENT, TEEKONIA DANIELLE
Entity Type:Individual
Prefix:
First Name:TEEKONIA
Middle Name:DANIELLE
Last Name:VINCENT
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 1:606 DAVE TRICKETT LN
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:WV
Mailing Address - Zip Code:26374-8280
Mailing Address - Country:US
Mailing Address - Phone:304-864-6245
Mailing Address - Fax:
Practice Address - Street 1:606 DAVE TRICKETT LN
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:WV
Practice Address - Zip Code:26374-8280
Practice Address - Country:US
Practice Address - Phone:304-864-6245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant