Provider Demographics
NPI:1548803539
Name:BIGGERSTAFF, TERI DEA
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:DEA
Last Name:BIGGERSTAFF
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:PO BOX 451
Mailing Address - Street 2:
Mailing Address - City:CHRISTOVAL
Mailing Address - State:TX
Mailing Address - Zip Code:76935-0451
Mailing Address - Country:US
Mailing Address - Phone:325-212-9002
Mailing Address - Fax:
Practice Address - Street 1:4366 CARTER AVE
Practice Address - Street 2:
Practice Address - City:CHRISTOVAL
Practice Address - State:TX
Practice Address - Zip Code:76935-0451
Practice Address - Country:US
Practice Address - Phone:325-212-9002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX799933163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice