Provider Demographics
NPI:1215705496
Name:TECLEZION, KATHY ANN (BSN, RN)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:TECLEZION
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 AKERS RIDGE DR SE # 527
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3217
Mailing Address - Country:US
Mailing Address - Phone:678-439-1382
Mailing Address - Fax:
Practice Address - Street 1:527 AKERS RIDGE DR SE # 527
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3217
Practice Address - Country:US
Practice Address - Phone:678-439-1382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN225111171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach