Provider Demographics
NPI:1386031052
Name:WHEELER, TERESA ANN
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:WHEELER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S BOOTH ST
Mailing Address - Street 2:
Mailing Address - City:MART
Mailing Address - State:TX
Mailing Address - Zip Code:76664-1503
Mailing Address - Country:US
Mailing Address - Phone:254-749-3732
Mailing Address - Fax:
Practice Address - Street 1:201 S BOOTH ST
Practice Address - Street 2:
Practice Address - City:MART
Practice Address - State:TX
Practice Address - Zip Code:76664-1503
Practice Address - Country:US
Practice Address - Phone:254-749-3732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2012639314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility