1275548851 NPI number — MS. GWENDOLYN TEESHA MCDANIEL CFNP

Table of content: MS. GWENDOLYN TEESHA MCDANIEL CFNP (NPI 1275548851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275548851 NPI number — MS. GWENDOLYN TEESHA MCDANIEL CFNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDANIEL
Provider First Name:
GWENDOLYN
Provider Middle Name:
TEESHA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CFNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NOE
Provider Other First Name:
GWENDOLYN
Provider Other Middle Name:
TEESHA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CFNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275548851
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3889
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNSON CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37602-3889
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-794-2457
Provider Business Mailing Address Fax Number:
423-283-9480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 E BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37821-2329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-237-6900
Provider Business Practice Location Address Fax Number:
423-532-8710
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  APN0000010486 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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