Healthcare Provider Details

I. General information

NPI: 1487519617
Provider Name (Legal Business Name): EMILY TEAGUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 SOUTHERN BLVD
KETTERING OH
45429-1221
US

IV. Provider business mailing address

55 BETHEL RD
DAYTON OH
45458-2464
US

V. Phone/Fax

Practice location:
  • Phone: 937-298-4331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number157119
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: