Healthcare Provider Details

I. General information

NPI: 1003984782
Provider Name (Legal Business Name): THERESA M KALB N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 REDSTONE DR UNIT 21
BRISTOL TN
37620-2980
US

IV. Provider business mailing address

527 REDSTONE DR UNIT 21
BRISTOL TN
37620-2980
US

V. Phone/Fax

Practice location:
  • Phone: 607-351-1793
  • Fax:
Mailing address:
  • Phone: 607-351-1793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number334836
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000837
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024173573
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPN0000021325
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberLG-0000837
License Number StateDE
# 6
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP012425
License Number StatePA
# 7
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF334836
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: