Provider Demographics
NPI:1841512019
Name:SMITH-KNUPPEL, TERESA KAY (MD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:KAY
Last Name:SMITH-KNUPPEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:KAY
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4820 ROSS RD
Mailing Address - Street 2:
Mailing Address - City:DEL VALLE
Mailing Address - State:TX
Mailing Address - Zip Code:78617
Mailing Address - Country:US
Mailing Address - Phone:512-516-8450
Mailing Address - Fax:512-516-8460
Practice Address - Street 1:4820 ROSS RD
Practice Address - Street 2:
Practice Address - City:DEL VALLE
Practice Address - State:TX
Practice Address - Zip Code:78617
Practice Address - Country:US
Practice Address - Phone:512-516-8450
Practice Address - Fax:512-516-8460
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2817207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB108216OtherMEDICARE
TXP00905758OtherMEDICARE RAIL ROAD
TX214920503Medicaid
TX214920501Medicaid
TX260375YLPSOtherWELLMED PTAN