Provider Demographics
NPI:1679823470
Name:GRAVELY, TENEIKA A (FNP)
Entity Type:Individual
Prefix:MS
First Name:TENEIKA
Middle Name:A
Last Name:GRAVELY
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 1:160 DARTMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1006
Mailing Address - Country:US
Mailing Address - Phone:716-819-7701
Mailing Address - Fax:
Practice Address - Street 1:160 DARTMOUTH AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1006
Practice Address - Country:US
Practice Address - Phone:716-819-7701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345689363LF0000X
NY650530-1163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical