Provider Demographics
NPI:1003984782
Name:KALB, THERESA M (NP)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:M
Last Name:KALB
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 1:527 REDSTONE DR UNIT 21
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-2980
Mailing Address - Country:US
Mailing Address - Phone:607-351-1793
Mailing Address - Fax:
Practice Address - Street 1:527 REDSTONE DR UNIT 21
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-2980
Practice Address - Country:US
Practice Address - Phone:607-351-1793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334836363LF0000X
DELG-0000837363LF0000X, 363LP2300X
VA0024173573363LP2300X
TNAPN0000021325363LP2300X
PASP012425363LP2300X
NYF334836363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1003984782OtherNPI