Healthcare Provider Details

I. General information

NPI: 1972410504
Provider Name (Legal Business Name): TEAGAN P BARNES NUDD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W 95TH ST STE 308
OAK LAWN IL
60453-2660
US

IV. Provider business mailing address

4400 W 95TH ST STE 308
OAK LAWN IL
60453-2660
US

V. Phone/Fax

Practice location:
  • Phone: 708-346-4040
  • Fax: 708-346-3287
Mailing address:
  • Phone: 708-346-4040
  • Fax: 708-346-3287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209036493
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: