Provider Demographics
NPI:1437469236
Name:VARNEY, TERESA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:VARNEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HIGHLAWN HTS
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-1320
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 HIGHLAWN HTS
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-1320
Practice Address - Country:US
Practice Address - Phone:304-000-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01509363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810024049OtherGROUP MEDICAID
WVB441OtherGROUP MEDICARE
WV1437469236OtherMEDICAID REFERRING PROVIDER (THSPP)
WV1437469236OtherMEDICAID REFERRING PROVIDER (THSPP)