Provider Demographics
NPI:1265179089
Name:MUSKET, TERESA LOUISE (RN)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LOUISE
Last Name:MUSKET
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 ESSEX DR
Mailing Address - Street 2:
Mailing Address - City:BLUFF CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37618-1241
Mailing Address - Country:US
Mailing Address - Phone:423-963-7822
Mailing Address - Fax:
Practice Address - Street 1:2203 MCKINLEY RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6893
Practice Address - Country:US
Practice Address - Phone:423-928-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000135992163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine