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NPI Code Detail

MEDICARE: TEAGAN RENEE TERRY

MEDICARE: TEAGAN RENEE TERRY
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1770276875
Entity Type Code : Individual
Provider Name (Legal Business Name) : TEAGAN RENEE TERRY
Provider Business Mailing Address
First Line : 4130 LINDEN AVE STE 245
Second Line :
City : DAYTON
State : OH
Zip : 45432-3049
Country : US
Telephone Number : 937-716-1791
Fax Number :
Provider Business Practice Location Address
First Line : 4130 LINDEN AVE STE 245
Second Line :
City : DAYTON
State : OH
Zip : 45432-3049
Country : US
Telephone Number : 937-716-1791
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2023
Last Update Date : 02/02/2026

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1396498655 — MRS. CHINAH LYNN JACKSON
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Directions to “ TEAGAN RENEE TERRY ” Practice Location

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