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General NPI Number Information
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NPI Number | 1538791611
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Entity Type | Individual
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Provider Name | MICHELLE TEAGUE NP
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Gender | Female
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Dates
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Enumeration Date | 02/06/2020
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 2275 INDIA HOOK RD
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City | ROCK HILL
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State | SC
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Zip | 29732-1223
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Country | US
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Telephone | 803-329-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 104 CHESTNUT ST
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City | GREENVILLE
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State | SC
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Zip | 29605-4301
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Country | US
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Telephone | 864-522-8603
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 23596
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 23596
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License Number State | SC
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