Provider Demographics
NPI:1659315661
Name:DYSON, TERESSA ANNETTE (CRNA)
Entity type:Individual
Prefix:
First Name:TERESSA
Middle Name:ANNETTE
Last Name:DYSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 SANDY CT
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-9302
Mailing Address - Country:US
Mailing Address - Phone:903-815-9390
Mailing Address - Fax:972-540-0733
Practice Address - Street 1:5327 N CENTRAL EXPY
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-3361
Practice Address - Country:US
Practice Address - Phone:903-815-9390
Practice Address - Fax:972-540-0733
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX525603367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8007UUOtherBCBS
TX088616002Medicaid
TX088616004Medicaid
TX088616002Medicaid
TX8L10630Medicare PIN