MEDICARE: MRS. TERESA FAYE BOUDRIE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WE0003X	Emergency Registered Nurse	130082	TN

General Provider Information

NPI Number	:	1053541326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERESA FAYE BOUDRIE RN

Provider Business Mailing Address
First Line	:	9215 ELKHORN RD
Second Line	:
City	:	SPRINGVILLE
State	:	TN
Zip	:	38256-4962
Country	:	US
Telephone Number	:	731-336-2598
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 JOEL DR
Second Line	:
City	:	FORT CAMPBELL
State	:	KY
Zip	:	42223-5318
Country	:	US
Telephone Number	:	270-798-8500
Fax Number	:	270-798-8666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2009
Last Update Date	:	07/21/2009

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