Provider Demographics
NPI:1194715466
Name:HEADSTREAM, TERESA KAYE (FNP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:KAYE
Last Name:HEADSTREAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:KAYE
Other - Last Name:HOWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5409
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5409
Mailing Address - Country:US
Mailing Address - Phone:325-793-5130
Mailing Address - Fax:325-793-5133
Practice Address - Street 1:1665 ANTILLEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5265
Practice Address - Country:US
Practice Address - Phone:325-793-5130
Practice Address - Fax:325-793-5133
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX592049363LF0000X
TXAP114252363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G1482Medicare PIN