Provider Demographics
NPI:1568247658
Name:GLADNEY, TINEKA ODESSA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:TINEKA
Middle Name:ODESSA
Last Name:GLADNEY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:WEIR
Mailing Address - State:MS
Mailing Address - Zip Code:39772-9164
Mailing Address - Country:US
Mailing Address - Phone:662-705-0168
Mailing Address - Fax:
Practice Address - Street 1:26894 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-7546
Practice Address - Country:US
Practice Address - Phone:662-494-3640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906186363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner