Provider Demographics
NPI:1194524868
Name:TEAGUE, CASEY CHRISTINE
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:CHRISTINE
Last Name:TEAGUE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MERRYMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-5011
Mailing Address - Country:US
Mailing Address - Phone:864-887-6316
Mailing Address - Fax:
Practice Address - Street 1:10 MERRYMOUNT DR
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-5011
Practice Address - Country:US
Practice Address - Phone:864-887-6316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC52586164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse