Provider Demographics
NPI:1144705591
Name:BLAKENEY, TERESA RENEE
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:RENEE
Last Name:BLAKENEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2769 E STATE HIGHWAY 176
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:TX
Mailing Address - Zip Code:79714-9432
Mailing Address - Country:US
Mailing Address - Phone:432-238-8323
Mailing Address - Fax:
Practice Address - Street 1:2769 E STATE HIGHWAY 176
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:TX
Practice Address - Zip Code:79714-9432
Practice Address - Country:US
Practice Address - Phone:432-238-8323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX677560163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse