Provider Demographics
NPI:1912232141
Name:TEAGUE, LEE ANNE (MSSW, NHA)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ANNE
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:MSSW, NHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MCCAIN AVE
Mailing Address - Street 2:
Mailing Address - City:MC KENZIE
Mailing Address - State:TN
Mailing Address - Zip Code:38201-2439
Mailing Address - Country:US
Mailing Address - Phone:731-393-0136
Mailing Address - Fax:731-393-0158
Practice Address - Street 1:207 N BREWER ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4027
Practice Address - Country:US
Practice Address - Phone:731-393-0136
Practice Address - Fax:731-393-0158
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL4392372600000X, 376J00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445210Medicaid