Provider Demographics
NPI:1053541326
Name:BOUDRIE, TERESA FAYE (RN)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:FAYE
Last Name:BOUDRIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:TERESA
Other - Middle Name:FAYE
Other - Last Name:MANER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9215 ELKHORN RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38256-4962
Mailing Address - Country:US
Mailing Address - Phone:731-336-2598
Mailing Address - Fax:
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5318
Practice Address - Country:US
Practice Address - Phone:270-798-8500
Practice Address - Fax:270-798-8666
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN130082163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency