Provider Demographics
NPI:1083474977
Name:CRAIGHEAD, TEOSHA PATRICE
Entity Type:Individual
Prefix:
First Name:TEOSHA
Middle Name:PATRICE
Last Name:CRAIGHEAD
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 1:1619 E STEWARTS LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37218-2509
Mailing Address - Country:US
Mailing Address - Phone:615-600-9154
Mailing Address - Fax:
Practice Address - Street 1:3201 S CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-4307
Practice Address - Country:US
Practice Address - Phone:504-207-3060
Practice Address - Fax:504-464-1386
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program