Individual
TYKERRA GILLIAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1027 NORTHRIDGE ST, WALNUT COVE, NC 27052-6972
(336) 681-6674
Mailing address
1027 NORTHRIDGE ST, WALNUT COVE, NC 27052-6972
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
91064
NC
Other
Enumeration date
05/04/2026
Last updated
05/04/2026
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