Provider Demographics
NPI:1790223444
Name:FOX, TEKIRA
Entity Type:Individual
Prefix:
First Name:TEKIRA
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TEKIRA
Other - Middle Name:T
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:230 EAST MAIN STREET #1264
Mailing Address - Street 2:
Mailing Address - City:GRAMERCY
Mailing Address - State:LA
Mailing Address - Zip Code:70052-1264
Mailing Address - Country:US
Mailing Address - Phone:225-623-9887
Mailing Address - Fax:
Practice Address - Street 1:1500 LAFAYETTE ST. STE 140
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053
Practice Address - Country:US
Practice Address - Phone:504-558-4931
Practice Address - Fax:504-558-4937
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA171M00000XMedicaid