Individual
AMY KATHRYN TEAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110840841
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C06695
GROUP PTAN
VA
01
—
C06778
MEDICARE PTAN
VA
Enumeration date
02/08/2007
Last updated
06/16/2018
Update your record
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