1780120097 NPI number — TERESA RHEW APRN

Table of content: TERESA RHEW APRN (NPI 1780120097)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780120097 NPI number — TERESA RHEW APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RHEW
Provider First Name:
TERESA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FERRICHER
Provider Other First Name:
TERESA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780120097
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 497
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72006-0497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-347-2534
Provider Business Mailing Address Fax Number:
501-279-9011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 RODGERS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEARCY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72143-7432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-279-7979
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2017

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: 163W00000X , with the licence number:  R055430 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: A005166 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 220709758 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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