Healthcare Provider Details

I. General information

NPI: 1366361388
Provider Name (Legal Business Name): TEAGAN DEMOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 MESSIMER DR
NEWARK OH
43055-1874
US

IV. Provider business mailing address

1275 GREEN VALLEY DR UNIT A
HEATH OH
43056-9321
US

V. Phone/Fax

Practice location:
  • Phone: 740-522-8477
  • Fax:
Mailing address:
  • Phone: 304-299-3806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberW.2600528
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: