MEDICARE: TERESA MICHELLE MUSGROVE RN

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	163WH0200X	Home Health Registered Nurse	607367	TX

General Provider Information

NPI Number	:	1689488504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA MICHELLE MUSGROVE RN

Provider Business Mailing Address
First Line	:	604 E HIRAM ST
Second Line	:
City	:	ATLANTA
State	:	TX
Zip	:	75551-2632
Country	:	US
Telephone Number	:	903-748-2294
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 E HIRAM ST
Second Line	:
City	:	ATLANTA
State	:	TX
Zip	:	75551-2632
Country	:	US
Telephone Number	:	903-748-2294
Fax Number	:

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

Provider Enumeration Date	:	02/03/2025
Last Update Date	:	02/03/2025

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