Provider Demographics
NPI:1851317663
Name:VANCE, TERESA MAE (FNP)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:MAE
Last Name:VANCE
Suffix:
Gender:F
Credentials:FNP
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 297
Mailing Address - Street 2:
Mailing Address - City:MEADOWVIEW
Mailing Address - State:VA
Mailing Address - Zip Code:24361-0297
Mailing Address - Country:US
Mailing Address - Phone:276-496-4492
Mailing Address - Fax:
Practice Address - Street 1:308 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SALTVILLE
Practice Address - State:VA
Practice Address - Zip Code:24370-3112
Practice Address - Country:US
Practice Address - Phone:276-496-4433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11328363L00000X
SC22019363L00000X
TNAPN0000011328363L00000X
VA0024169576363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010242312Medicaid
TNTN0122OtherUNITED HEALTHCARE RIVER VALLEY
TN3700035Medicaid
TN4166092OtherBCBS
TNP00323569OtherRAILROAD MEDICARE
TNVV2978BMedicare PIN
TN4166092OtherBCBS
VA010242312Medicaid
TN103I509567Medicare PIN