Provider Demographics
NPI:1669265278
Name:STARKS, TEGWEN LOU (RN)
Entity type:Individual
Prefix:MS
First Name:TEGWEN
Middle Name:LOU
Last Name:STARKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TEGWEN
Other - Middle Name:LOU
Other - Last Name:STARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 COMMERCE DR STE 208
Mailing Address - Street 2:
Mailing Address - City:WESTOVER
Mailing Address - State:WV
Mailing Address - Zip Code:26501-3858
Mailing Address - Country:US
Mailing Address - Phone:304-285-5500
Mailing Address - Fax:304-285-2787
Practice Address - Street 1:11 COMMERCE DR STE 208
Practice Address - Street 2:
Practice Address - City:WESTOVER
Practice Address - State:WV
Practice Address - Zip Code:26501-3858
Practice Address - Country:US
Practice Address - Phone:304-285-5500
Practice Address - Fax:304-285-2787
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV54664163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse