Provider Demographics
NPI:1356843528
Name:MEKO, TENISHA L (NP-C)
Entity type:Individual
Prefix:
First Name:TENISHA
Middle Name:L
Last Name:MEKO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3422 SIXES RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-9120
Mailing Address - Country:US
Mailing Address - Phone:943-202-7670
Mailing Address - Fax:470-986-7143
Practice Address - Street 1:3422 SIXES RD STE 102
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-9120
Practice Address - Country:US
Practice Address - Phone:943-202-7670
Practice Address - Fax:470-986-7143
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA241316163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse