Provider Demographics
NPI:1639322100
Name:WALTERS, TERESA A (PA-C; DHSC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:WALTERS
Suffix:
Gender:F
Credentials:PA-C; DHSC
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:A
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C; DHSC
Mailing Address - Street 1:13715 MORNINGBLUFF DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-1650
Mailing Address - Country:US
Mailing Address - Phone:910-551-1144
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-221-6130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant