Provider Demographics
NPI:1457944951
Name:GEORGE, THERESA ROSE (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ROSE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24299 FLAX RD
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-6167
Mailing Address - Country:US
Mailing Address - Phone:704-652-2387
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL PARK BLVD STE 205E
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7507
Practice Address - Country:US
Practice Address - Phone:423-844-5520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180917363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner