Basic Information
| Provider Information | |||||||||
| NPI: | 1194756924 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEESE | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | APRN MSN BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 DESIARD STREET | ||||||||
| Address2: | SUITE 355 | ||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3188077875 | ||||||||
| FaxNumber: | 3188126603 | ||||||||
| Practice Location | |||||||||
| Address1: | 102 THOMAS ROAD | ||||||||
| Address2: | SUITE 400 B | ||||||||
| City: | WEST MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3189980353 | ||||||||
| FaxNumber: | 3189980357 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 04/17/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN051725AP0407 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1037397 | 05 | LA | MEDICAID |