Provider Demographics
NPI:1093796435
Name:CALLAHAN, TERESA LEILA (FNP)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:LEILA
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 BRIARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-2763
Mailing Address - Country:US
Mailing Address - Phone:432-689-2901
Mailing Address - Fax:432-639-6292
Practice Address - Street 1:5315 BRIARWOOD AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-2763
Practice Address - Country:US
Practice Address - Phone:432-689-2901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP113148363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N7039OtherBLUE CROSS PROVIDER NUMB
TX135953OtherCHIPS PROVIDER NUMBER
TX147620100OtherFIRST CARE PROVIDER #
TX170817401Medicaid
TX170817401Medicaid
TX8D0439Medicare PIN