Provider Demographics
NPI:1932108099
Name:SMITH, TERESA WELLS (ARNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:WELLS
Last Name:SMITH
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 1:3355 BEAR GRASS RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-8277
Mailing Address - Country:US
Mailing Address - Phone:252-809-6400
Mailing Address - Fax:252-809-6409
Practice Address - Street 1:102 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2156
Practice Address - Country:US
Practice Address - Phone:252-809-6400
Practice Address - Fax:252-809-6409
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201973363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003679Medicaid
NCQ42510Medicare UPIN
NC2592324Medicare ID - Type Unspecified