Provider Demographics
NPI:1215167333
Name:PARHAM, TERESA DAVIS (FNP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:DAVIS
Last Name:PARHAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 DURANT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-1614
Mailing Address - Country:US
Mailing Address - Phone:434-584-0046
Mailing Address - Fax:434-333-7035
Practice Address - Street 1:420 DURANT ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-1614
Practice Address - Country:US
Practice Address - Phone:434-584-0046
Practice Address - Fax:434-584-0083
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5001114363LF0000X
NC0050-01114363LF0000X
VA0024172253363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5001114OtherNC LICENSE
VA0024172253OtherVA LICENSE