Provider Demographics
NPI:1679088173
Name:TEEGARDEN, DONNA (RN CDE MLDE)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:TEEGARDEN
Suffix:
Gender:F
Credentials:RN CDE MLDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41004-0117
Mailing Address - Country:US
Mailing Address - Phone:606-735-2157
Mailing Address - Fax:
Practice Address - Street 1:429 FRANKFORT ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41004-8312
Practice Address - Country:US
Practice Address - Phone:606-735-2157
Practice Address - Fax:606-735-2159
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1083603163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator