| Doctor Name: | JENNIFER ELIZABETH TEETERS |
| NPI Number: | 1912994633 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 3003862 |
| Business Practice Address: | 100 Brianna Boulevard Suite 100 Salyersville, KY - 414659811 |
| Business Phone Number: | 6063493800 |
| Business Fax Number: | 6062635619 |
| Mailing Address: | Po Box 406, PRESTONSBURG |
| State: | KY |
| Postal Code: | 416530406 |
| Phone Number: | 6063493800 |
| Fax Number: | 6062635619 |
| NPI Enumeration Date: | 09/29/2005 |
| NPI Last Update Date: | 10/20/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 3003862 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |