Provider Demographics
NPI:1275679532
Name:THAYER, TERESA A (MSN APRN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:THAYER
Suffix:
Gender:F
Credentials:MSN APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MCGHEE ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-6811
Mailing Address - Country:US
Mailing Address - Phone:865-983-4582
Mailing Address - Fax:865-681-0079
Practice Address - Street 1:301 MCGHEE ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-6811
Practice Address - Country:US
Practice Address - Phone:865-983-4582
Practice Address - Fax:865-681-0079
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005923363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNS61129Medicare UPIN