Provider Demographics
NPI:1386636603
Name:NEPRUD, TERESA (NP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:NEPRUD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:BRADBERRY
Other - Last Name:STANFILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:411 WALNUT ST # 13588
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-3443
Mailing Address - Country:US
Mailing Address - Phone:410-353-7961
Mailing Address - Fax:
Practice Address - Street 1:2821 DAGGETT AVE STE 200
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1130
Practice Address - Country:US
Practice Address - Phone:541-274-8400
Practice Address - Fax:541-274-8406
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60856983363LF0000X
MDR200127363LF0000X
MECNP231210363LF0000X
OR201909625NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD258291OtherJHHC
MD587105100Medicaid
243408YT9AMedicare PIN