Healthcare Provider Details

I. General information

NPI: 1710793146
Provider Name (Legal Business Name): COURTNEY JESSICA TEAGUE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY JESSICA CHRISTENSEN

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N ROSE AVE
OXNARD CA
93030-3722
US

IV. Provider business mailing address

2434 HICKORY ST
ABILENE TX
79698-0001
US

V. Phone/Fax

Practice location:
  • Phone: 805-988-2500
  • Fax:
Mailing address:
  • Phone: 325-660-2774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number65659
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: