Provider Demographics
NPI:1144584897
Name:AYERS, TERESA RENEE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:RENEE
Last Name:AYERS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:RENEE
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1601 KESTERSON RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:VA
Mailing Address - Zip Code:24248-8066
Mailing Address - Country:US
Mailing Address - Phone:606-337-3051
Mailing Address - Fax:606-337-1128
Practice Address - Street 1:850 RIVERVIEW AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-1452
Practice Address - Country:US
Practice Address - Phone:606-337-3051
Practice Address - Fax:606-337-1128
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000016740367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1529824Medicaid
TN1529824Medicaid