Provider Demographics
NPI:1598392375
Name:BOOMER, TESHEIKA NAVOY (FNP, PMHNP)
Entity type:Individual
Prefix:
First Name:TESHEIKA
Middle Name:NAVOY
Last Name:BOOMER
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 CROCKETT RIDGE CT E
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28574-7471
Mailing Address - Country:US
Mailing Address - Phone:910-650-6592
Mailing Address - Fax:910-597-1689
Practice Address - Street 1:203 CROCKETT RIDGE CT E
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:NC
Practice Address - Zip Code:28574-7471
Practice Address - Country:US
Practice Address - Phone:910-650-6592
Practice Address - Fax:910-597-1689
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF12190403363LF0000X
NC2022091499363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5013170OtherNC STATE LICENCES
NC5013170OtherNC STATE LICENCES