Provider Demographics
NPI:1619384328
Name:OUTMAN, THERESA LYNN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:LYNN
Last Name:OUTMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MAIN ST
Mailing Address - Street 2:ONEONTA PEDIATRICS
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2507
Mailing Address - Country:US
Mailing Address - Phone:607-433-6511
Mailing Address - Fax:607-433-6608
Practice Address - Street 1:125 MAIN ST
Practice Address - Street 2:ONEONTA PEDIATRICS
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2507
Practice Address - Country:US
Practice Address - Phone:607-433-6511
Practice Address - Fax:607-433-6608
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338998-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily