Provider Demographics
NPI:1023664778
Name:POOL, TYDESHEAIA LADEJENEE
Entity type:Individual
Prefix:
First Name:TYDESHEAIA
Middle Name:LADEJENEE
Last Name:POOL
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 1:2996 WESTVISTA CIR APT 2996
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-5792
Mailing Address - Country:US
Mailing Address - Phone:601-810-4101
Mailing Address - Fax:
Practice Address - Street 1:1300 CEDAR BRANCH DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-6678
Practice Address - Country:US
Practice Address - Phone:601-810-4101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide