Healthcare Provider Details

I. General information

NPI: 1437130408
Provider Name (Legal Business Name): TERESA A RASMUSSEN P.A.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1579 TAZEWELL RD
TAZEWELL TN
37879-3607
US

IV. Provider business mailing address

1579 TAZEWELL RD
TAZEWELL TN
37879-3607
US

V. Phone/Fax

Practice location:
  • Phone: 423-259-3955
  • Fax: 877-358-9236
Mailing address:
  • Phone: 423-259-3955
  • Fax: 877-358-9236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0719
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: