Provider Demographics
NPI:1316959216
Name:TEVEBAUGH, CHARLES W (APN)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:W
Last Name:TEVEBAUGH
Suffix:
Gender:M
Credentials:APN
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Mailing Address - Street 1:12 E APPLEBY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703
Mailing Address - Country:US
Mailing Address - Phone:479-463-4444
Mailing Address - Fax:479-463-4499
Practice Address - Street 1:12 E APPLEBY
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:479-463-4444
Practice Address - Fax:479-463-4499
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARA01080363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology