Provider Demographics
NPI:1740730290
Name:ROSEBERRY, TERESA (CNP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:ROSEBERRY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 PHILLIPS ROAD 253 LOOP
Mailing Address - Street 2:
Mailing Address - City:LEXA
Mailing Address - State:AR
Mailing Address - Zip Code:72355-8366
Mailing Address - Country:US
Mailing Address - Phone:501-269-0972
Mailing Address - Fax:
Practice Address - Street 1:4501 GLENMERE RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7405
Practice Address - Country:US
Practice Address - Phone:501-269-0972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-08
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004912363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care