Provider Demographics
NPI:1760949473
Name:TATUM, DENISHIA KARNELL (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:DENISHIA
Middle Name:KARNELL
Last Name:TATUM
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2744 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-1638
Mailing Address - Country:US
Mailing Address - Phone:762-822-3430
Mailing Address - Fax:
Practice Address - Street 1:1610 OPELIKA RD
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-3634
Practice Address - Country:US
Practice Address - Phone:334-291-0221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-113817363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics