Provider Demographics
NPI:1154863082
Name:RUDD, TERESA MICHELLE (MSN, RN, AGACNP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MICHELLE
Last Name:RUDD
Suffix:
Gender:F
Credentials:MSN, RN, AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3444
Mailing Address - Country:US
Mailing Address - Phone:210-737-5100
Mailing Address - Fax:
Practice Address - Street 1:1502 HOWARD ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3444
Practice Address - Country:US
Practice Address - Phone:210-737-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132548363LA2100X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care