Provider Demographics
NPI:1821013053
Name:TEAGARDEN, LORETTA (ARNP)
Entity type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:
Last Name:TEAGARDEN
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 1:1615 SW 8TH AVE
Mailing Address - Street 2:SHAWNEE COUNTY
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1633
Mailing Address - Country:US
Mailing Address - Phone:785-368-2000
Mailing Address - Fax:785-368-2098
Practice Address - Street 1:1615 SW 8TH AVE
Practice Address - Street 2:SHAWNEE COUNTY
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1633
Practice Address - Country:US
Practice Address - Phone:785-368-2000
Practice Address - Fax:785-368-2098
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS044108363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSS74374Medicare UPIN
KS160210Medicare ID - Type Unspecified