Provider Demographics
NPI:1114351814
Name:NASH, TEAH KERR (PA-C)
Entity Type:Individual
Prefix:
First Name:TEAH
Middle Name:KERR
Last Name:NASH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TEAH
Other - Middle Name:CRYSTAL
Other - Last Name:HAGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5030 YORKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:283 MADONNA RD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-5432
Practice Address - Country:US
Practice Address - Phone:805-549-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPA23265363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program