Provider Demographics
NPI:1982675351
Name:BEHL, TERESA R (PAC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:R
Last Name:BEHL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:FREEMAN
Mailing Address - State:SD
Mailing Address - Zip Code:57029-0900
Mailing Address - Country:US
Mailing Address - Phone:605-925-4219
Mailing Address - Fax:
Practice Address - Street 1:804 WALNUT ST
Practice Address - Street 2:
Practice Address - City:FREEMAN
Practice Address - State:SD
Practice Address - Zip Code:57029-0900
Practice Address - Country:US
Practice Address - Phone:605-925-4219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0471363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6823522Medicaid
SD6823520Medicaid
SD6823522Medicaid