Individual
TYESHA SELF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
265 TOM LN, GREENSBURG, LA 70441-3142
(225) 460-1447
Mailing address
265 TOM LN, GREENSBURG, LA 70441-3142
(225) 460-1447
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
LA
Other
Enumeration date
04/22/2026
Last updated
04/22/2026
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