Active NPI
Teresa Lynn Bracken, RP
- Pharmacist
- Scottsbluff, NE
National Provider Identifier
1861599243
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 12464
- Practice address
- 205 W 27TH St
Scottsbluff, NE 69361-4307 - Phone
- (308) 635-3296
- NPI assigned
- Sep 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 12464 | NE | Primary |
| Pharmacist | 183500000X | 14371-040 | WI |
Addresses
Primary practice location
205 W 27TH St
Scottsbluff, NE 69361-4307
Mailing address
1520 17TH St
Gering, NE 69341-2702
Phone (308) 883-1092
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14371-040 | Other | WI | PHARMACIST LICENSE |
| 12464 | Other | NE | PHARMACIST LICENSE |
Other names 1
- Teresa Lynn Gray
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12464 | NE | MD | Pharmacist |
| 14371-040 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Pharmacy
- Scottsbluff, NE
- NPI 1174538128
-
- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861599243",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1520 17TH ST",
"city": "GERING",
"state": "NE",
"postal_code": "693412702",
"telephone_number": "308-883-1092"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 W 27TH ST",
"city": "SCOTTSBLUFF",
"state": "NE",
"postal_code": "693614307",
"telephone_number": "308-635-3296"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRACKEN",
"first_name": "TERESA",
"middle_name": "LYNN",
"credential": "RP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NE",
"license": "12464",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "14371-040",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST LICENSE",
"identifier": "14371-040",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST LICENSE",
"identifier": "12464",
"state": "NE"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "TERESA",
"last_name": "GRAY",
"middle_name": "LYNN",
"credential": "RP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Scottsbluff, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.