Provider Demographics
NPI:1366894602
Name:HEDRICK, TEENA (NP)
Entity type:Individual
Prefix:
First Name:TEENA
Middle Name:
Last Name:HEDRICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 TANNER WAY
Mailing Address - Street 2:STE 200
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-8302
Mailing Address - Country:US
Mailing Address - Phone:865-376-6272
Mailing Address - Fax:865-376-0341
Practice Address - Street 1:1855 TANNER WAY
Practice Address - Street 2:STE 200
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8302
Practice Address - Country:US
Practice Address - Phone:865-376-6272
Practice Address - Fax:865-376-0341
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21349363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ023576Medicaid
TN103I506729Medicare PIN