Individual
MS. CAROL A TEAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1000 N JEFFERSON ST, ST JAMES, MO 65401
(573) 265-8840
(573) 265-8884
Mailing address
1050 W 10TH ST, ATTN: EXECUTIVE DIRECTOR OF PHYSICIAN CLINICS, ROLLA, MO 65401-2905
(573) 364-9000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
076310
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477625531
—
MO
05
—
424848406
—
MO
Enumeration date
11/14/2006
Last updated
08/22/2019
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