Teresa Tyson, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024119161 Issued in VA

Practice address

208 Front St W
Coeburn, VA 24230-3502

Phone

(276) 455-5556

NPI assigned

Sep 8, 2006

Last updated

Mar 20, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Teresa Gardner Former name

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Appalachian Center for Excellence in Healthcare IncGroup PAC ID 6507108545, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/AHJBBA/Endpoint/AHJBBA

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Appalachian Center for Excellence in Healthcare Inc

  • Rural Health Clinic/Center
  • Coeburn, VA
  • NPI 1669294385

  5% Or Greater Direct Ownership Interest, W-2 Managing Employee

  CMS ownership

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Appalachian Center for Excellence in Healthcare Inc

  • Family Nurse Practitioner
  • Coeburn, VA
  • NPI 1003380759
  Medicare reassignment Care Compare group NPD
• Click Care LLC

  • Nurse Practitioner
  • Coeburn, VA
  • NPI 1558900852
  NPD Authorized official
• Appalachian Center for Excellence in Healthcare Inc

  • Rural Health Clinic/Center
  • Coeburn, VA
  • NPI 1669294385
  NPD
• St. Mary's Health Wagon

  • Dental Clinic/Center
  • Wise, VA
  • NPI 1083324735
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553040000000",
    "number": "1013011337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 90",
            "city": "COEBURN",
            "state": "VA",
            "postal_code": "242300090",
            "telephone_number": "276-328-8850",
            "fax_number": "276-328-8853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 FRONT ST W",
            "city": "COEBURN",
            "state": "VA",
            "postal_code": "242303502",
            "telephone_number": "276-455-5556"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5626 Patriot Dr.",
            "address_purpose": "LOCATION",
            "city": "Wise",
            "state": "VA",
            "postal_code": "24293",
            "country_code": "US",
            "telephone_number": "276-328-8850",
            "fax_number": "276-328-8853",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TYSON",
        "first_name": "TERESA",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-08",
        "last_updated": "2019-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024119161",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01059873",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TERESA",
            "last_name": "GARDNER",
            "credential": "FNP-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Scarlett Ann Solomon, PHARMACIST
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• St Charles Health Council Inc (Coeburn Family Health Center)
• Leandra Stanley, PMHNP-BC
• Ttgi Corp (Spartan Drug)
• Matthew Scott Villiard, RPH
• Walgreen Co (Walgreens #17546)
• Adrienne Angelopoulos Ward, MS, CCC-SLP
• Caleb Williams, NRP
• Jimmy F Williams Jr.

• Family Nurse Practitioner in Coeburn, VA
• Providers in Coeburn, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.