Healthcare Provider Details

I. General information

NPI: 1427183458
Provider Name (Legal Business Name): TERESA LYNN CASTEEL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 DR MARTIN LUTHER KING JR AVE NE SUITE 301
ALBUQUERQUE NM
87102-3661
US

IV. Provider business mailing address

715 DR MARTIN LUTHER KING JR AVE NE SUITE 301
ALBUQUERQUE NM
87102-3661
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-7090
  • Fax: 505-727-7099
Mailing address:
  • Phone: 505-727-7090
  • Fax: 505-727-7099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberR1565450
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0992244-NP
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP-03000
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: