Provider Demographics
NPI:1114152402
Name:SMITH, TERESA MAYER (RN, NP-C)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:MAYER
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN, NP-C
Other - Prefix:MS
Other - First Name:TERESA
Other - Middle Name:ANN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, NP-C
Mailing Address - Street 1:4401 GARTH RD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-2122
Mailing Address - Country:US
Mailing Address - Phone:832-556-6351
Mailing Address - Fax:713-799-9598
Practice Address - Street 1:4401 GARTH RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2122
Practice Address - Country:US
Practice Address - Phone:832-556-6351
Practice Address - Fax:713-799-9598
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX596961363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health