Individual
TANISHA DANIELLE PUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
913C TINY TOWN RD STE 114, CLARKSVILLE, TN 37042-4603
(912) 492-2233
Mailing address
1571 EDGEWATER LN, CLARKSVILLE, TN 37043-1547
(912) 492-2233
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
—
Other
Enumeration date
10/24/2017
Last updated
10/24/2017
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