Provider Demographics
NPI:1548724537
Name:LANDRUM, TERESA SUSAN (APRN)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:SUSAN
Last Name:LANDRUM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1535
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-5535
Mailing Address - Country:US
Mailing Address - Phone:606-627-6371
Mailing Address - Fax:
Practice Address - Street 1:1927 S US HIGHWAY 25E
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-7600
Practice Address - Country:US
Practice Address - Phone:606-546-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily