Theresia Renner, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA195 Issued in KY

Practice address

200 Clinic Dr
Madisonville, KY 42431-1661

Phone

(270) 825-7200

NPI assigned

Sep 17, 2006

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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

• Ohio Valley Neurology LLC

  • Neurology Physician
  • Madisonville, KY
  • NPI 1023005394
  NPD

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

{
    "created_epoch": "1158451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303171200000",
    "number": "1740387372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CLINIC DR",
            "city": "MADISONVILLE",
            "state": "KY",
            "postal_code": "424311661",
            "telephone_number": "270-825-7200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 CLINIC DR",
            "city": "MADISONVILLE",
            "state": "KY",
            "postal_code": "424311661",
            "telephone_number": "270-825-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENNER",
        "first_name": "THERESIA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-17",
        "last_updated": "2011-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "KY",
            "license": "PA195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "000000107779",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PA195",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Morse, LLC
• Janella Redfern
• Regional Health Care Affiliates Inc
• Susan Reid
• Kavya Mounika Remala, MD
• Whitney Jo Ressett, PT, DPT, OCS
• Revive Chiropractic LLC
• Torie Reynolds
• Stuart Wayne Rice, M.D.
• Jerry Rickard

• Surgical Physician Assistant in Madisonville, KY
• Providers in Madisonville, KY by specialty
• Surgical Physician Assistant in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2011; 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.