Provider Demographics
NPI:1821236555
Name:TEER, MISTIE RACHELLE (APRN)
Entity Type:Individual
Prefix:
First Name:MISTIE
Middle Name:RACHELLE
Last Name:TEER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MISTIE
Other - Middle Name:RACHELLE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2700 STANLEY GAULT PKWY STE 129
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5176
Mailing Address - Country:US
Mailing Address - Phone:502-253-4900
Mailing Address - Fax:502-489-5750
Practice Address - Street 1:3950 KRESGE WAY STE 207
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-893-0220
Practice Address - Fax:502-893-0563
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005928363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201342940Medicaid
KY7100086330Medicaid
KYK053660Medicare PIN