Provider Demographics
NPI:1598788309
Name:CALHOUN, THERESA (CRNP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:CRNP
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 129
Mailing Address - Street 2:
Mailing Address - City:TONEY
Mailing Address - State:AL
Mailing Address - Zip Code:35773-0129
Mailing Address - Country:US
Mailing Address - Phone:256-859-2918
Mailing Address - Fax:
Practice Address - Street 1:8208 HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:TONEY
Practice Address - State:AL
Practice Address - Zip Code:35773-8125
Practice Address - Country:US
Practice Address - Phone:256-859-2918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1083858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1083858OtherLICENSE NUMBER