Provider Demographics
NPI:1972027860
Name:WHITE, TERI ANDREA (1744P3200X)
Entity Type:Individual
Prefix:MS
First Name:TERI
Middle Name:ANDREA
Last Name:WHITE
Suffix:
Gender:F
Credentials:1744P3200X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011B NW BROAD ST STE 15
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2326
Mailing Address - Country:US
Mailing Address - Phone:615-900-5561
Mailing Address - Fax:
Practice Address - Street 1:1011-B NW BROARD ST
Practice Address - Street 2:SUITE 15
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130
Practice Address - Country:US
Practice Address - Phone:615-900-5561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1744P3200X
1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty