Provider Demographics
NPI:1144207499
Name:TENPENNY, TERESA RENEE (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:RENEE
Last Name:TENPENNY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:14395 STATE RT 93
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640
Practice Address - Country:US
Practice Address - Phone:740-288-7681
Practice Address - Fax:740-288-7683
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40537207Q00000X
OH35.081393207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2354483Medicaid
KY7100013370Medicaid
OH2354483Medicaid
KY7100013370Medicaid
H69144Medicare UPIN
KY058668Medicare PIN