Provider Demographics
NPI:1588188429
Name:JOSEPH, TYSHEEN R
Entity Type:Individual
Prefix:
First Name:TYSHEEN
Middle Name:R
Last Name:JOSEPH
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:PO BOX 362
Mailing Address - Street 2:
Mailing Address - City:STOWELL
Mailing Address - State:TX
Mailing Address - Zip Code:77661-0362
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1544 CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:STOWELL
Practice Address - State:TX
Practice Address - Zip Code:77661
Practice Address - Country:US
Practice Address - Phone:409-665-5494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide