Healthcare Provider Details

I. General information

NPI: 1972192136
Provider Name (Legal Business Name): TERESA DIANN REXRODE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESA DIANN HINES FNP-BC

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 NEW CREEK HWY
KEYSER WV
26726-9526
US

IV. Provider business mailing address

514 NEW CREEK HWY
KEYSER WV
26726-9526
US

V. Phone/Fax

Practice location:
  • Phone: 304-359-3500
  • Fax:
Mailing address:
  • Phone: 304-359-5627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number106873
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number106873
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number106873
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: