Provider Demographics
NPI:1093796567
Name:TURGEON, TERESA LEA (PA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LEA
Last Name:TURGEON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 GOLDEN RIDGE RD STE 250
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-9541
Mailing Address - Country:US
Mailing Address - Phone:303-332-1223
Mailing Address - Fax:
Practice Address - Street 1:141 INDUSTRIAL AVE
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-2901
Practice Address - Country:US
Practice Address - Phone:817-444-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1337363A00000X
KS1500344363A00000X
COPA.0004378363A00000X
IA073544363A00000X
TXPA02648363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47084595513Medicaid
NEP00458223OtherMEDICARE RAILROAD
KS100343050BMedicaid
NE47084595513Medicaid
NE281833Medicare PIN
KS100343050BMedicaid
NE47084595513Medicaid