Provider Demographics
NPI:1922283670
Name:TERESA SHEFFIELD APRN LLC
Entity Type:Organization
Organization Name:TERESA SHEFFIELD APRN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHEFFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-487-0720
Mailing Address - Street 1:805 N MAIN ST
Mailing Address - Street 2:P.O BOX 728
Mailing Address - City:TOMPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42167-1002
Mailing Address - Country:US
Mailing Address - Phone:270-487-0720
Mailing Address - Fax:270-487-0712
Practice Address - Street 1:805 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TOMPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42167-1002
Practice Address - Country:US
Practice Address - Phone:270-487-0720
Practice Address - Fax:270-487-0712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4917P261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYQ76055Medicare UPIN