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Individual
TERESA W ELLIS
Active
Individual
TERESA W ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
3007458
KY
363LF0000X
Family Nurse Practitioner
0024087401
VA
363LF0000X
Family Nurse Practitioner
Primary
3007458
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100007360
—
KY
Enumeration date
01/30/2006
Last updated
12/05/2024
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