Provider Demographics
NPI:1467115212
Name:FAULKS, TIERRA
Entity Type:Individual
Prefix:MISS
First Name:TIERRA
Middle Name:
Last Name:FAULKS
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 1:1413 W PELICAN CT
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-7204
Mailing Address - Country:US
Mailing Address - Phone:480-738-9211
Mailing Address - Fax:
Practice Address - Street 1:1413 W PELICAN CT
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-7204
Practice Address - Country:US
Practice Address - Phone:480-738-9211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ000000OtherNON HE