MEDICARE: TERESA KEITH COLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	3008855	KY
2	363L00000X	Nurse Practitioner	3008855	KY

General Provider Information

NPI Number	:	1588073886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA KEITH COLE

Provider Business Mailing Address
First Line	:	509 MEMORIAL DR STE 2
Second Line	:
City	:	MANCHESTER
State	:	KY
Zip	:	40962-6196
Country	:	US
Telephone Number	:	606-598-5104
Fax Number	:	606-598-0983

Provider Business Practice Location Address
First Line	:	509 MEMORIAL DR STE 2
Second Line	:
City	:	MANCHESTER
State	:	KY
Zip	:	40962-6196
Country	:	US
Telephone Number	:	606-598-5104
Fax Number	:	606-598-0983

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2014
Last Update Date	:	02/24/2020

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Directions to “ TERESA KEITH COLE ” Practice Location

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