Provider Demographics
NPI:1881629244
Name:TEAGARDEN, JENNIFER (PA- C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:TEAGARDEN
Suffix:
Gender:F
Credentials:PA- C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15359-1001
Mailing Address - Country:US
Mailing Address - Phone:724-499-5188
Mailing Address - Fax:724-499-5847
Practice Address - Street 1:140 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15359-1001
Practice Address - Country:US
Practice Address - Phone:724-499-5188
Practice Address - Fax:724-499-5847
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002654L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant