Provider Demographics
NPI:1053091595
Name:HERRINGTON, TAMEKA DAWANETTIONETTE
Entity type:Individual
Prefix:
First Name:TAMEKA
Middle Name:DAWANETTIONETTE
Last Name:HERRINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3392 STAMPLEY RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MS
Mailing Address - Zip Code:39069-4719
Mailing Address - Country:US
Mailing Address - Phone:601-807-2627
Mailing Address - Fax:
Practice Address - Street 1:1109 CARTER ST STE 10
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:LA
Practice Address - Zip Code:71373-3227
Practice Address - Country:US
Practice Address - Phone:318-336-4700
Practice Address - Fax:318-336-4777
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17643171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator