Provider Demographics
NPI:1568132306
Name:RICHARDSON, TENISHA TYWANNA
Entity Type:Individual
Prefix:
First Name:TENISHA
Middle Name:TYWANNA
Last Name:RICHARDSON
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 1:10706 N CHISHOLM TRAIL BLVD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-1489
Mailing Address - Country:US
Mailing Address - Phone:405-888-3376
Mailing Address - Fax:
Practice Address - Street 1:10706 N CHISHOLM TRAIL BLVD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73025-1489
Practice Address - Country:US
Practice Address - Phone:405-888-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator