Provider Demographics
NPI:1639481450
Name:GONZALEZ, TERESA D (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:D
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 CARRIAGE HILL DR STE B
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5329
Mailing Address - Country:US
Mailing Address - Phone:870-573-2200
Mailing Address - Fax:870-573-2300
Practice Address - Street 1:3501 CARRIAGE HILL DR STE B
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-5329
Practice Address - Country:US
Practice Address - Phone:870-573-2200
Practice Address - Fax:870-573-2300
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03399ANP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR184459758Medicaid
AR184459758Medicaid