Provider Demographics
NPI:1194756924
Name:DEESE, TERESA ANNE (APRN MSN BC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANNE
Last Name:DEESE
Suffix:
Gender:F
Credentials:APRN MSN BC
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:130 DESIARD STREET
Mailing Address - Street 2:SUITE 355
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201
Mailing Address - Country:US
Mailing Address - Phone:318-807-7875
Mailing Address - Fax:318-812-6603
Practice Address - Street 1:102 THOMAS ROAD
Practice Address - Street 2:SUITE 400 B
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291
Practice Address - Country:US
Practice Address - Phone:318-998-0353
Practice Address - Fax:318-998-0357
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2015-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LARN051725AP0407363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1037397Medicaid
LA1037397Medicaid
4C296Medicare ID - Type Unspecified
LA1037397Medicaid