Healthcare Provider Details

I. General information

NPI: 1619124948
Provider Name (Legal Business Name): MRS. TERESA ANN OSBORNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13520 HIGHWAY 119 S
PARTRIDGE KY
40862-6417
US

IV. Provider business mailing address

13520 HIGHWAY 119 S
PARTRIDGE KY
40862-6417
US

V. Phone/Fax

Practice location:
  • Phone: 606-589-4586
  • Fax: 606-589-5930
Mailing address:
  • Phone: 606-589-4586
  • Fax: 606-589-5930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number4207
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: