Healthcare Provider Details

I. General information

NPI: 1659087112
Provider Name (Legal Business Name): TERESA GEVEDON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 US HIGHWAY 460 E
FRENCHBURG KY
40322-8384
US

IV. Provider business mailing address

PO BOX 690
BEATTYVILLE KY
41311-0690
US

V. Phone/Fax

Practice location:
  • Phone: 606-768-3725
  • Fax: 606-464-0152
Mailing address:
  • Phone: 606-464-0151
  • Fax: 606-464-0152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3018905
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: