Provider Demographics
NPI:1710580162
Name:CONNOR, TERESA KAYE
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:KAYE
Last Name:CONNOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:KAYE
Other - Last Name:CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1304 ERMINE PL
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-9179
Mailing Address - Country:US
Mailing Address - Phone:304-677-2583
Mailing Address - Fax:
Practice Address - Street 1:SUITE 120 EASTLAND SQUARE
Practice Address - Street 2:503 MORGANTOWN AVE
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554
Practice Address - Country:US
Practice Address - Phone:304-363-7376
Practice Address - Fax:304-471-2488
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator