Provider Demographics
NPI:1568765030
Name:PATTERSON, TIEESHA TASHAY (CNA,& PSYCH TECH)
Entity Type:Individual
Prefix:
First Name:TIEESHA
Middle Name:TASHAY
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:CNA,& PSYCH TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14203 RAVENHURST LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-3214
Mailing Address - Country:US
Mailing Address - Phone:281-964-9914
Mailing Address - Fax:
Practice Address - Street 1:14203 RAVENHURST LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3214
Practice Address - Country:US
Practice Address - Phone:281-964-9914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide