Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 334836 | NY |
N | 363LF0000X | Nurse Practitioner - Family Medicine | LG-0000837 | DE |
N | 363LP2300X | Nurse Practitioner - Primary Care | 0024173573 | VA |
N | 363LP2300X | Nurse Practitioner - Primary Care | APN0000021325 | TN |
Y | 363LP2300X | Nurse Practitioner - Primary Care | F334836 | NY |
N | 363LP2300X | Nurse Practitioner - Primary Care | LG-0000837 | DE |
N | 363LP2300X | Nurse Practitioner - Primary Care | SP012425 | PA |
NPI | 1003984782 |
---|---|
Provider Name | Mrs. Theresa M Kalb |
First Address | Bristol, TN 37620-2980 |
Second Address | Bristol, TN 37620-2980 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003984782 | NPI (01) | DE |