Provider Demographics
NPI:1598885550
Name:LORD, TERESA JUNE BURNETTE (MD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:JUNE BURNETTE
Last Name:LORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2205 PAVILION DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4641
Mailing Address - Country:US
Mailing Address - Phone:423-857-6466
Mailing Address - Fax:423-857-6456
Practice Address - Street 1:505 NE 87TH AVE STE 320
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1965
Practice Address - Country:US
Practice Address - Phone:360-514-2550
Practice Address - Fax:360-514-1927
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN51856207RX0202X
GARTP001763207V00000X
WAMD61401415207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology