MEDICARE: TEANA ELMER APRN - CNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1072449	TX

General Provider Information

NPI Number	:	1982351136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEANA ELMER APRN - CNP

Provider Business Mailing Address
First Line	:	PO BOX 2255
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76244-2255
Country	:	US
Telephone Number	:	817-854-3201
Fax Number	:	817-259-2609

Provider Business Practice Location Address
First Line	:	1744 KELLER PKWY
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-3704
Country	:	US
Telephone Number	:	817-854-3201
Fax Number	:	817-259-2609

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

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	01/28/2024

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