Provider Demographics
NPI:1114231016
Name:KEIRNS, TERESA BURNELLE (RN, CNM)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:BURNELLE
Last Name:KEIRNS
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MONTE AVE
Mailing Address - Street 2:C/O SHERRIS/LACITIS
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94611-3718
Mailing Address - Country:US
Mailing Address - Phone:401-225-6167
Mailing Address - Fax:
Practice Address - Street 1:2051 JOHN JONES RD
Practice Address - Street 2:DAVIS COMMUNITY CLINIC
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-9701
Practice Address - Country:US
Practice Address - Phone:530-758-2060
Practice Address - Fax:530-758-8490
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA730310163W00000X
OR201601564NP-PP367A00000X
CA1904367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse