Provider Demographics
NPI:1407653744
Name:TEEGARDEN, ERNEST ALLEN JR (CNP)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:ALLEN
Last Name:TEEGARDEN
Suffix:JR
Gender:
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 135
Mailing Address - Street 2:
Mailing Address - City:BIGFORK
Mailing Address - State:MN
Mailing Address - Zip Code:56628-0135
Mailing Address - Country:US
Mailing Address - Phone:218-743-3232
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 135
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MN
Practice Address - Zip Code:56628-0135
Practice Address - Country:US
Practice Address - Phone:218-743-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty