Provider Demographics
NPI:1164145298
Name:TEAH, JAEKAR (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JAEKAR
Middle Name:
Last Name:TEAH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10917 GOSSAMER LN
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-6106
Mailing Address - Country:US
Mailing Address - Phone:317-701-5831
Mailing Address - Fax:
Practice Address - Street 1:1000 VAN NUYS RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-9060
Practice Address - Country:US
Practice Address - Phone:317-701-5831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013060A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily