Provider Demographics
NPI:1134436652
Name:REID, TERESA NECOLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:NECOLE
Last Name:REID
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3109
Mailing Address - Country:US
Mailing Address - Phone:704-376-1605
Mailing Address - Fax:704-335-8448
Practice Address - Street 1:225 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3109
Practice Address - Country:US
Practice Address - Phone:704-376-1605
Practice Address - Fax:704-335-8448
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02500363A00000X
VA0110003352363A00000X
NMPA2015-0009363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM66136059Medicaid
NC8101511Medicaid
NC1134436652Medicaid
NCNC4242CMedicare PIN
NCNC4242FMedicare PIN
NM427024YNGGMedicare Oscar/Certification
NCNC4242HMedicare PIN
NCNC4242MMedicare PIN
NC1134436652Medicaid
NCNC4242GMedicare PIN
NCNC4242BMedicare PIN