Provider Demographics
NPI:1528647070
Name:FEDOSKY, TERESA (CPM)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:FEDOSKY
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 N SALEM RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5423
Mailing Address - Country:US
Mailing Address - Phone:479-409-5479
Mailing Address - Fax:479-571-4329
Practice Address - Street 1:3825 N SALEM RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-5423
Practice Address - Country:US
Practice Address - Phone:479-409-5479
Practice Address - Fax:479-571-4329
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No176B00000XOther Service ProvidersMidwife