Provider Demographics
NPI:1710152582
Name:FALKENBERRY, TETYANA G (MD)
Entity Type:Individual
Prefix:DR
First Name:TETYANA
Middle Name:G
Last Name:FALKENBERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TETYANA
Other - Middle Name:G
Other - Last Name:TACKETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:801 S UNIVERSITY BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-2949
Mailing Address - Country:US
Mailing Address - Phone:251-432-4117
Mailing Address - Fax:
Practice Address - Street 1:801 S UNIVERSITY BLVD STE D
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-2949
Practice Address - Country:US
Practice Address - Phone:251-432-4117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100056760Medicaid
0169Medicare PIN
KY00637054Medicare PIN