Healthcare Provider Details

I. General information

NPI: 1730759788
Provider Name (Legal Business Name): KIMBERLY ELIZABETH TEAGUE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 BARRETT DR STE 300
RALEIGH NC
27609-7172
US

IV. Provider business mailing address

5171 GLENWOOD AVE STE 204
RALEIGH NC
27612-3396
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-1806
  • Fax: 919-752-4756
Mailing address:
  • Phone: 919-782-1806
  • Fax: 919-752-4756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5014626
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: