1922399716 NPI number — MS. TERESA JOANNE ENRIGHT FNP

Table of content: MS. TERESA JOANNE ENRIGHT FNP (NPI 1922399716)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922399716 NPI number — MS. TERESA JOANNE ENRIGHT FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENRIGHT
Provider First Name:
TERESA
Provider Middle Name:
JOANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922399716
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14163
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
83002-4163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-739-7696
Provider Business Mailing Address Fax Number:
307-739-0734

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5235 HHR RANCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILSON
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
83014-9210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-739-7696
Provider Business Practice Location Address Fax Number:
307-739-0734
Provider Enumeration Date:
04/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  30108.1147 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: NP95015338 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 131038100 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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