Basic Information
| Provider Information | |||||||||
| NPI: | 1144239104 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHENEY | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | BROWER | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 GLYNCO PKWY | ||||||||
| Address2: | BLDG 1 STE10 | ||||||||
| City: | BRUNSWICK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315257921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9122649111 | ||||||||
| FaxNumber: | 9122626909 | ||||||||
| Practice Location | |||||||||
| Address1: | 586 BRANNEN ST | ||||||||
| Address2: | |||||||||
| City: | STATESBORO | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304585557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9128716611 | ||||||||
| FaxNumber: | 9128716612 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 05/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 066069 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 202I501197 | 01 | GA | MEDICARE PTAN NUMBER | OTHER | 000865686H | 05 | GA | MEDICAID |