Healthcare Provider Details

I. General information

NPI: 1487823704
Provider Name (Legal Business Name): TERESA M SCOGGINS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 E 30TH ST STE 102
FARMINGTON NM
87401-8990
US

IV. Provider business mailing address

2300 E 30TH ST STE 102
FARMINGTON NM
87401-8990
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-6790
  • Fax: 505-599-4640
Mailing address:
  • Phone: 505-609-6790
  • Fax: 505-599-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number002096
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA07283
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2026-0052
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2008002536
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: