Provider Demographics
NPI:1598392375
Name:BOOMER, TESHEIKA NAVOY (FNP)
Entity Type:Individual
Prefix:
First Name:TESHEIKA
Middle Name:NAVOY
Last Name:BOOMER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 E ARLINGTON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-7828
Mailing Address - Country:US
Mailing Address - Phone:252-756-4899
Mailing Address - Fax:252-756-4899
Practice Address - Street 1:1704 E ARLINGTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-7828
Practice Address - Country:US
Practice Address - Phone:252-756-4899
Practice Address - Fax:252-756-5141
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF12190403363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5013170OtherNC STATE LICENCES
NC5013170OtherNC STATE LICENCES