Organization
NP GERIATRIC ADULT CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA C PENNINGTON AGPCNP-BC (OWNER)
(276) 759-8825
Entity
Organization
Contact information
Practice address
500 CLINIC DR, CEDAR BLUFF, VA 24609-9406
(276) 596-9750
Mailing address
1048 TERRACE DR, MARION, VA 24354-4138
(276) 783-1827
(276) 783-2879
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
0024175955
VA
Other
Enumeration date
04/17/2018
Last updated
04/27/2018
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