Healthcare Provider Details

I. General information

NPI: 1427011527
Provider Name (Legal Business Name): TERESA SUE CALHOUN C-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 GOFF MOUNTAIN RD
CROSS LANES WV
25313-1419
US

IV. Provider business mailing address

PO BOX 1320
SAINT ALBANS WV
25177-1320
US

V. Phone/Fax

Practice location:
  • Phone: 304-776-4453
  • Fax: 304-776-4456
Mailing address:
  • Phone: 304-388-1764
  • Fax: 304-388-1721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: