Provider Demographics
NPI:1467020909
Name:BLACKSTON, TEAGAN ELISE
Entity type:Individual
Prefix:
First Name:TEAGAN
Middle Name:ELISE
Last Name:BLACKSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 N WOODS LN
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-6712
Mailing Address - Country:US
Mailing Address - Phone:479-636-3190
Mailing Address - Fax:
Practice Address - Street 1:3400 N WOODS LN
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-6712
Practice Address - Country:US
Practice Address - Phone:479-636-3190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist