Tequila J Staten, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

3006238 Issued in KY

Practice address

5796 Nashville Rd
Bowling Green, KY 42101

Phone

(270) 781-6477

Fax

(270) 781-6479

NPI assigned

Dec 23, 2009

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

Medicare fee-for-service enrollment

Enrolled in KY

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

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: tequilastaten@ggc.allscriptsdirect.net

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

{
    "created_epoch": "1261526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554336000000",
    "number": "1043549918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 PARK ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421011759",
            "telephone_number": "270-781-5111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5796 NASHVILLE RD",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "42101",
            "telephone_number": "270-781-6477",
            "fax_number": "270-781-6479"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1330 N Race St",
            "address_purpose": "LOCATION",
            "city": "Glasgow",
            "state": "KY",
            "postal_code": "421413465",
            "country_code": "US",
            "telephone_number": "270-629-5111",
            "fax_number": "270-629-5115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STATEN",
        "first_name": "TEQUILA",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-23",
        "last_updated": "2019-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3006238",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100170760",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Kay Staples, APRN
• Sabrina Lee Stapp
• Saundra Starks, ED.D., LCSW
• Starlight ABA Ky LLC
• Starting Point of Kentucky, PSC (Crossroads Treatment Center Bowling Green)
• William Jeremy Steakley, ATC
• Thelma Stearman, LPN
• Jerome Steckler III, D.C.
• Joseph Craft Steele, D.M.D.,M.S.
• Bobby Tanner T. Steelman, LCSW

• Family Nurse Practitioner in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Family Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.