Teena Marie Gannon

Primary specialty

Attendant Care ProviderTaxonomy code 3747A0650X

License

RP582668 Issued in OH

Practice address

1035 County Road 1 Apt.215
South Point, OH 45680-7382

Phone

(740) 302-7354

NPI assigned

Apr 13, 2021

Sex

Female

Sole proprietor

Yes

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1618272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618272000000",
    "number": "1801476940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2657 COUNTY ROAD 18",
            "city": "SOUTH POINT",
            "state": "OH",
            "postal_code": "456807382",
            "telephone_number": "740-302-7354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 COUNTY ROAD 1 APT.215",
            "city": "SOUTH POINT",
            "state": "OH",
            "postal_code": "456807382",
            "telephone_number": "740-302-7354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANNON",
        "first_name": "TEENA",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-13",
        "last_updated": "2021-04-13",
        "certification_date": "2021-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747A0650X",
            "taxonomy_group": "",
            "desc": "Technician, Attendant Care Provider",
            "state": "OH",
            "license": "RP582668",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHOICES",
            "identifier": "1022401",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1022Q401",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Attendant Care Provider in South Point, OH
• Providers in South Point, OH by specialty
• Attendant Care Provider in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2021; 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.