Provider Demographics
NPI:1558107417
Name:TEYSSIER, CARRIE (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:TEYSSIER
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MEDICAL CENTER DR STE C
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2362
Mailing Address - Country:US
Mailing Address - Phone:856-374-1881
Mailing Address - Fax:
Practice Address - Street 1:400 MEDICAL CENTER DR STE C
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2362
Practice Address - Country:US
Practice Address - Phone:856-374-1881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15093300363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology