Provider Demographics
NPI:1841241478
Name:BARSOTTI, TERESA K (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:K
Last Name:BARSOTTI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34756
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38184-0756
Mailing Address - Country:US
Mailing Address - Phone:901-382-1200
Mailing Address - Fax:901-382-8070
Practice Address - Street 1:401 E TICKLE ST
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-3119
Practice Address - Country:US
Practice Address - Phone:866-591-4362
Practice Address - Fax:731-286-0058
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000008853367500000X
TNAPN 8853163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1527735Medicaid
TN3630743Medicaid