Stephanie Renee Tickemyer

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

7707 Austin Rd
Stockton, CA 95215-8312

Phone

(951) 312-1688

NPI assigned

Jul 16, 2025

Last updated

Jul 17, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1752624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752710400000",
    "number": "1083506026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1154 FAIRWAY OAKS AVE",
            "city": "BANNING",
            "state": "CA",
            "postal_code": "922206411",
            "telephone_number": "951-312-1688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7707 AUSTIN RD",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952158312",
            "telephone_number": "951-312-1688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TICKEMYER",
        "first_name": "STEPHANIE",
        "middle_name": "RENEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-16",
        "last_updated": "2025-07-17",
        "certification_date": "2025-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tandrea Thysell
• Mark Anthony Tiano
• Raksmey Tiano, PHD
• Janessa Tibbot, RBT
• Jennifer Leann Tibbot, RBT
• Stacey Tidwell, LCSW
• Jill Marie Tiedeman, LMFT
• Tien Trong Vu, M.D. Inc.
• Jose Tienda, MS,ATC,CES
• Pedro Tienda Jr.

• Student in an Organized Health Care Education/Training Program in Stockton, CA
• Providers in Stockton, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.