Provider Demographics
NPI:1861662132
Name:HALL, TERESA D (NP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:D
Last Name:HALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:D
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:19500 IH 10 W STOP 1-3030
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-9509
Mailing Address - Country:US
Mailing Address - Phone:210-955-6729
Mailing Address - Fax:877-479-3805
Practice Address - Street 1:19500 IH 10 W STOP 1-3030
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-9509
Practice Address - Country:US
Practice Address - Phone:210-955-6729
Practice Address - Fax:877-479-3805
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX678104363LG0600X
TXAP115942363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX275671YMVUOtherWELLMED NETWORKS INC
TXB161964OtherWELLMED MEDICAL GROUP PA