Healthcare Provider Details

I. General information

NPI: 1164513628
Provider Name (Legal Business Name): TERESA KAE FREEMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SKYLINE DRIVE
RUSSELLVILLE AR
72801
US

IV. Provider business mailing address

350 SALEM ROAD SUITE 1
CONWAY AR
72034
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-1298
  • Fax: 479-698-6053
Mailing address:
  • Phone: 501-336-8300
  • Fax: 501-329-3572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR35902
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: