Provider Demographics
NPI:1275548851
Name:MCDANIEL, GWENDOLYN TEESHA (CFNP)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:TEESHA
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:GWENDOLYN
Other - Middle Name:TEESHA
Other - Last Name:NOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:PO BOX 3889
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-3889
Mailing Address - Country:US
Mailing Address - Phone:423-794-2457
Mailing Address - Fax:423-283-9480
Practice Address - Street 1:150 E BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-2329
Practice Address - Country:US
Practice Address - Phone:423-237-6900
Practice Address - Fax:423-532-8710
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000010486363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q29454Medicare UPIN