Provider Demographics
NPI:1972188084
Name:TIMMONS, THENESHA L (NP-C)
Entity Type:Individual
Prefix:
First Name:THENESHA
Middle Name:L
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:THENESA
Other - Middle Name:L
Other - Last Name:TIMMONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:156 SAPPHIRE LN
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-0119
Mailing Address - Country:US
Mailing Address - Phone:459-363-9220
Mailing Address - Fax:
Practice Address - Street 1:156 SAPPHIRE LN
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-0119
Practice Address - Country:US
Practice Address - Phone:459-363-9220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF03190616363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily