Provider Demographics
NPI:1881817450
Name:DUEITT, THERESA BARRETT (APRN,BC)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:BARRETT
Last Name:DUEITT
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-4354
Mailing Address - Country:US
Mailing Address - Phone:601-649-2863
Mailing Address - Fax:601-649-9479
Practice Address - Street 1:1203 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4354
Practice Address - Country:US
Practice Address - Phone:601-649-2863
Practice Address - Fax:601-649-9479
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR709271363L00000X, 363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02277797Medicaid
MS4741566OtherCIGNA
MSP00811329OtherRAILROAD MEDICARE
MSP00811329OtherRAILROAD MEDICARE