Provider Demographics
NPI:1205169273
Name:DOWLING, TERESA ANN (FNP-BC, PMHNP)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:ANN
Last Name:DOWLING
Suffix:
Gender:F
Credentials:FNP-BC, PMHNP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:ROTH-DOWLING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4972 COUNTY ROAD 38
Mailing Address - Street 2:
Mailing Address - City:FORT CALHOUN
Mailing Address - State:NE
Mailing Address - Zip Code:68023-5054
Mailing Address - Country:US
Mailing Address - Phone:402-641-8822
Mailing Address - Fax:
Practice Address - Street 1:4972 COUNTY ROAD 38
Practice Address - Street 2:
Practice Address - City:FORT CALHOUN
Practice Address - State:NE
Practice Address - Zip Code:68023-5054
Practice Address - Country:US
Practice Address - Phone:402-641-8822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE114254363LF0000X
IAG123175363LP0808X
IAA123175363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10027821400Medicaid
IA1114906906Medicaid
161803Medicare UPIN
49614Medicare UPIN