Provider Demographics
NPI:1922258268
Name:MCLEMORE, TERESA ANN (PA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:MCLEMORE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1505 LBJ FWY STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-6065
Mailing Address - Country:US
Mailing Address - Phone:214-358-2300
Mailing Address - Fax:214-579-6941
Practice Address - Street 1:1250 8TH AVE STE 135
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4156
Practice Address - Country:US
Practice Address - Phone:817-921-2153
Practice Address - Fax:214-579-6993
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA05908363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA05908OtherTX LICENSE
TX8L7838Medicare PIN
TX8L10314Medicare PIN