Provider Demographics
NPI:1982062758
Name:DOLES-JOHNSON, TEAH NAKESHA SHANTE' (AGNP)
Entity type:Individual
Prefix:
First Name:TEAH
Middle Name:NAKESHA SHANTE'
Last Name:DOLES-JOHNSON
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 BOULEVARD ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-3802
Mailing Address - Country:US
Mailing Address - Phone:336-781-2189
Mailing Address - Fax:
Practice Address - Street 1:320 BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3802
Practice Address - Country:US
Practice Address - Phone:336-781-2189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008340363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health