Provider Demographics
NPI:1699195438
Name:TEDDER, JOIE LYNN (APRN,FNP-C)
Entity type:Individual
Prefix:MS
First Name:JOIE
Middle Name:LYNN
Last Name:TEDDER
Suffix:
Gender:F
Credentials:APRN,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 HANCOCK RD
Mailing Address - Street 2:BLDG C, STE 302
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8624
Mailing Address - Country:US
Mailing Address - Phone:928-440-6995
Mailing Address - Fax:928-404-9175
Practice Address - Street 1:1225 HANCOCK RD
Practice Address - Street 2:BLDG C, STE 302
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442
Practice Address - Country:US
Practice Address - Phone:928-440-6995
Practice Address - Fax:928-404-9175
Is Sole Proprietor?:No
Enumeration Date:2014-04-20
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ235928363LF0000X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201108380AMedicaid
AZ003840Medicaid
KSMT3334303OtherDEA