Provider Demographics
NPI:1124702816
Name:PRICE, TYKHEEMA KEIARA
Entity type:Individual
Prefix:
First Name:TYKHEEMA
Middle Name:KEIARA
Last Name:PRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TYKHEEMA
Other - Middle Name:KEIARA
Other - Last Name:LASTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8301 16 1/2 MILE RD APT 23
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-1847
Mailing Address - Country:US
Mailing Address - Phone:248-819-0197
Mailing Address - Fax:
Practice Address - Street 1:1841 N PERRY ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-2235
Practice Address - Country:US
Practice Address - Phone:248-745-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator