Mary F Teague, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA16824 Issued in CA

Practice address

1235 Osos St
Suite 100
San Luis Obispo, CA 93401-3600

Phone

(805) 549-0888

Fax

(805) 549-8463

NPI assigned

Apr 13, 2007

Last updated

Nov 30, 2012By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354233600000",
    "number": "1598989147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 OSOS ST",
            "address_2": "SUITE 100",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934013600",
            "telephone_number": "805-549-0888",
            "fax_number": "805-549-8463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 OSOS ST",
            "address_2": "SUITE 100",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934013600",
            "telephone_number": "805-549-0888",
            "fax_number": "805-549-8463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEAGUE",
        "first_name": "MARY",
        "middle_name": "F",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-13",
        "last_updated": "2012-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA16824",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIANS ASSISTANT",
            "identifier": "PA16824",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Taylor, RBT
• Melanee Taylor
• Michelle Alena Taylor, R.N., M.S.N., A.C.N.
• Robyn Michelle Taylor
• Sarah Michel Taylor, PA-C
• Stephanie Teague
• Charlotte Ann Techau, M.A
• Kelly Ann Techau
• Caitlin Teixeira
• Paul A. Teixeira, P.T.

• Physician Assistant in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.