Provider Demographics
NPI:1417517145
Name:BUFORD, TENISHA
Entity Type:Individual
Prefix:
First Name:TENISHA
Middle Name:
Last Name:BUFORD
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 1:600 DOROTHY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-3544
Mailing Address - Country:US
Mailing Address - Phone:501-650-1353
Mailing Address - Fax:
Practice Address - Street 1:600 DOROTHY DR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-3544
Practice Address - Country:US
Practice Address - Phone:501-650-1353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide