Provider Demographics
NPI:1194776039
Name:TATE, TERESA LYNN (APRN,BC)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:LYNN
Last Name:TATE
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:MS
Other - First Name:TERESA
Other - Middle Name:LYNN
Other - Last Name:HANFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-BC
Mailing Address - Street 1:106 LOCKHEED DR
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:WV
Mailing Address - Zip Code:25813-8962
Mailing Address - Country:US
Mailing Address - Phone:304-253-5155
Mailing Address - Fax:304-536-5031
Practice Address - Street 1:106 LOCKHEED DR
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813-8962
Practice Address - Country:US
Practice Address - Phone:304-253-5155
Practice Address - Fax:691-207-7011
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV51350363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1611OtherRXA
WV3810007225Medicaid