Provider Demographics
NPI:1275167447
Name:WARD, TERESA LYNN (ACNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:WARD
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1320
Mailing Address - Country:US
Mailing Address - Phone:304-363-6210
Mailing Address - Fax:304-363-0952
Practice Address - Street 1:1703 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1320
Practice Address - Country:US
Practice Address - Phone:304-363-6210
Practice Address - Fax:304-363-0952
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV105701363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner