Provider Demographics
NPI:1245192269
Name:CUNNINGHAM, TYKERIA
Entity type:Individual
Prefix:
First Name:TYKERIA
Middle Name:
Last Name:CUNNINGHAM
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 1:615 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-3824
Mailing Address - Country:US
Mailing Address - Phone:636-310-8127
Mailing Address - Fax:636-310-8127
Practice Address - Street 1:615 WILSHIRE DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-3824
Practice Address - Country:US
Practice Address - Phone:636-310-8127
Practice Address - Fax:636-310-8127
Is Sole Proprietor?:No
Enumeration Date:2025-11-28
Last Update Date:2025-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021024272163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation