Provider Demographics
NPI:1164909164
Name:TEATS-GARRISON, KIMBERLY V (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:V
Last Name:TEATS-GARRISON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:V
Other - Last Name:TEATS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:915 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5099
Mailing Address - Country:US
Mailing Address - Phone:563-243-2511
Mailing Address - Fax:
Practice Address - Street 1:1130 17TH ST STE B
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:IL
Practice Address - Zip Code:61252-2008
Practice Address - Country:US
Practice Address - Phone:815-589-2005
Practice Address - Fax:815-632-5975
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant