Provider Demographics
NPI:1619283710
Name:TENYA, FON AUGUSTIN
Entity Type:Individual
Prefix:
First Name:FON
Middle Name:AUGUSTIN
Last Name:TENYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 FOREST LN STE 1053
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7513
Mailing Address - Country:US
Mailing Address - Phone:972-333-8122
Mailing Address - Fax:
Practice Address - Street 1:2828 FOREST LN STE 1053
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7513
Practice Address - Country:US
Practice Address - Phone:972-333-8122
Practice Address - Fax:972-243-1754
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX372600000X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker