Individual
SHADA BREEZE TENNYSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1018 N GLOSTER ST, TUPELO, MS 38804-1297
(662) 523-4950
(662) 890-5746
Mailing address
1018 N GLOSTER ST, TUPELO, MS 38804-1297
(662) 523-4950
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
903537
MS
Other
Enumeration date
10/07/2019
Last updated
11/14/2023
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