Provider Demographics
NPI:1669922308
Name:WOERNER, TERYN DENAE (PA)
Entity type:Individual
Prefix:
First Name:TERYN
Middle Name:DENAE
Last Name:WOERNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TERYN
Other - Middle Name:D
Other - Last Name:LASESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 CHILDRENS WAY # 653
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-1100
Mailing Address - Fax:501-364-4082
Practice Address - Street 1:1 CHILDRENS WAY # 210
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-7598
Practice Address - Fax:501-364-6889
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR146D00000X
ARPA-681363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant