Provider Demographics
NPI:1306565577
Name:NEMEC, TELISHA MOONEY (NP)
Entity type:Individual
Prefix:
First Name:TELISHA
Middle Name:MOONEY
Last Name:NEMEC
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 OLYMPIC PLAZA CIR STE 420
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1952
Mailing Address - Country:US
Mailing Address - Phone:903-531-8950
Mailing Address - Fax:903-509-5835
Practice Address - Street 1:700 OLYMPIC PLAZA CIR STE 420
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1952
Practice Address - Country:US
Practice Address - Phone:903-531-8950
Practice Address - Fax:903-509-5835
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1008174363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner