Provider Demographics
NPI:1689079790
Name:WILDER, TEAIRAH (FNP)
Entity Type:Individual
Prefix:
First Name:TEAIRAH
Middle Name:
Last Name:WILDER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22335 US HIGHWAY 72 STE C
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-2611
Mailing Address - Country:US
Mailing Address - Phone:256-870-4111
Mailing Address - Fax:256-870-4112
Practice Address - Street 1:102 ESSEX CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-3160
Practice Address - Country:US
Practice Address - Phone:256-461-8442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-131546163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse