Provider Demographics
NPI:1649337841
Name:WOOSLEY, TERESA A (ARNP)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:A
Last Name:WOOSLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-450-6815
Mailing Address - Fax:812-450-6822
Practice Address - Street 1:2622 MENARDS DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8075
Practice Address - Country:US
Practice Address - Phone:812-450-2622
Practice Address - Fax:812-471-2063
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4384P363LF0000X
IN71007633A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000390072OtherANTHEM BLUE CROSS
KY78012952Medicaid
1195470OtherCHA HEALTH
KY7890042000OtherKENPAC
KY78012952Medicaid