Provider Demographics
NPI:1386748804
Name:RASHEED, TERESSA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TERESSA
Middle Name:
Last Name:RASHEED
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TERESSA
Other - Middle Name:
Other - Last Name:WOODSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1217 OAKLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-1125
Mailing Address - Country:US
Mailing Address - Phone:817-457-3853
Mailing Address - Fax:817-457-2794
Practice Address - Street 1:1217 OAKLAND BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-1125
Practice Address - Country:US
Practice Address - Phone:817-457-3853
Practice Address - Fax:817-457-2794
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02216363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211965303Medicaid
TX211965304Medicaid
TX211965301Medicaid
TX211965302Medicaid
86N037Medicare ID - Type Unspecified
TX211965302Medicaid
TX8L15404Medicare PIN
TX8L15495Medicare PIN
TXP32512Medicare UPIN
TX211965303Medicaid