Provider Demographics
NPI:1881876092
Name:TEBO, TERRI JEAN (RN,CRNP)
Entity type:Individual
Prefix:MS
First Name:TERRI
Middle Name:JEAN
Last Name:TEBO
Suffix:
Gender:F
Credentials:RN,CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 EDISON DR
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36201-4827
Mailing Address - Country:US
Mailing Address - Phone:256-343-5489
Mailing Address - Fax:
Practice Address - Street 1:1449 TEMPLE RD
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:GA
Practice Address - Zip Code:30110-2378
Practice Address - Country:US
Practice Address - Phone:770-537-2367
Practice Address - Fax:706-270-5111
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-124702163WP0808X
AL1-12472363LP0808X
GARN119908363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health