Basic Information
| Provider Information | |||||||||
| NPI: | 1932449386 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEWART | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 152 MISTON TANK RD | ||||||||
| Address2: | |||||||||
| City: | RIDGELY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380805300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7314453516 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1700 WOODLAWN AVENUE | ||||||||
| Address2: | |||||||||
| City: | DYERSBURG | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380241572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7312874500 | ||||||||
| FaxNumber: | 7312874804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2013 | ||||||||
| LastUpdateDate: | 04/01/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 17412 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.