1548577885 NPI number — MRS. TERESA KAY LONG RN, BSN, COHN-S

Table of content: MRS. TERESA KAY LONG RN, BSN, COHN-S (NPI 1548577885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548577885 NPI number — MRS. TERESA KAY LONG RN, BSN, COHN-S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LONG
Provider First Name:
TERESA
Provider Middle Name:
KAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, BSN, COHN-S
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:
1548577885
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
126 MISSOURI AVE
Provider Second Line Business Mailing Address:
OCCUPATIONAL HEALTH BOX 1227
Provider Business Mailing Address City Name:
FORT LEONARD WOOD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65473-8952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-329-1993
Provider Business Mailing Address Fax Number:
573-329-8521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
197 REPLACEMENT AVE
Provider Second Line Business Practice Location Address:
SUITE 139
Provider Business Practice Location Address City Name:
FORT LEONARD WOOD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65473-9089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-329-1933
Provider Business Practice Location Address Fax Number:
573-329-8521
Provider Enumeration Date:
09/08/2010

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: 163WX0106X , with the licence number:  103766 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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