Doctor Name: | MS. TEQUILA J STATEN |
NPI Number: | 1043549918 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ARNP |
License Number: | 3006238 |
Business Practice Address: | 1330 N Race St Glasgow, KY - 421413465 |
Business Phone Number: | 2706295111 |
Business Fax Number: | 2706295115 |
Mailing Address: | 201 Park St, BOWLING GREEN |
State: | KY |
Postal Code: | 421011759 |
Phone Number: | 2707802497 |
Fax Number: | 2707833750 |
NPI Enumeration Date: | 12/23/2009 |
NPI Last Update Date: | 07/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 3006238 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |