Provider Demographics
NPI:1134742505
Name:DENSON, TEMEKA (LPN, CCMA,)
Entity type:Individual
Prefix:MRS
First Name:TEMEKA
Middle Name:
Last Name:DENSON
Suffix:
Gender:F
Credentials:LPN, CCMA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MEADOW HILL DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074-3817
Mailing Address - Country:US
Mailing Address - Phone:601-507-1375
Mailing Address - Fax:
Practice Address - Street 1:104 MEADOW HILL DR
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074-3817
Practice Address - Country:US
Practice Address - Phone:601-401-2846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory