Provider Demographics
NPI:1891925004
Name:RENFROW, TERESA A (ARNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:RENFROW
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 STATE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4976
Mailing Address - Country:US
Mailing Address - Phone:812-945-2229
Mailing Address - Fax:812-949-2229
Practice Address - Street 1:1425 STATE ST STE 100
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4976
Practice Address - Country:US
Practice Address - Phone:812-945-2229
Practice Address - Fax:812-949-2229
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47805363LP0200X
IN71003203A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201283520Medicaid
ININ1189116OtherIN MEDICARE