Provider Demographics
NPI:1295508224
Name:PAUL-STALLWORTH, TRIKENYA UWANA (APRN PMHNP)
Entity type:Individual
Prefix:MRS
First Name:TRIKENYA
Middle Name:UWANA
Last Name:PAUL-STALLWORTH
Suffix:
Gender:F
Credentials:APRN PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4247 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-0703
Mailing Address - Country:US
Mailing Address - Phone:850-766-0492
Mailing Address - Fax:
Practice Address - Street 1:820 E PARK AVE STE 100
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2610
Practice Address - Country:US
Practice Address - Phone:850-966-2145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11029224363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health