Provider Demographics
NPI:1861097479
Name:STROUT, TEEIA (FNP)
Entity type:Individual
Prefix:
First Name:TEEIA
Middle Name:
Last Name:STROUT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TEEIA
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1109 LINDSEY LN
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-8456
Mailing Address - Country:US
Mailing Address - Phone:405-778-0031
Mailing Address - Fax:
Practice Address - Street 1:1109 LINDSEY LN
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-8456
Practice Address - Country:US
Practice Address - Phone:405-778-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0112399363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily