Provider Demographics
NPI:1104409804
Name:KIGHT, TYREISHA
Entity type:Individual
Prefix:
First Name:TYREISHA
Middle Name:
Last Name:KIGHT
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 1:1833 WESSEX DR APT 4
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-4853
Mailing Address - Country:US
Mailing Address - Phone:901-343-0218
Mailing Address - Fax:855-718-9975
Practice Address - Street 1:1833 WESSEX DR APT 4
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-4853
Practice Address - Country:US
Practice Address - Phone:901-343-0218
Practice Address - Fax:855-718-9975
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1000000028434251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health