Provider Demographics
NPI:1861559098
Name:KEVIL, TERESA T (APRN, BC, ANP)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:T
Last Name:KEVIL
Suffix:
Gender:F
Credentials:APRN, BC, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 COLONY BND
Mailing Address - Street 2:#195
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-3159
Mailing Address - Country:US
Mailing Address - Phone:318-677-3086
Mailing Address - Fax:318-677-3068
Practice Address - Street 1:1233 SPRAGUE ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-3349
Practice Address - Country:US
Practice Address - Phone:318-227-2912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN032673 - APO1989363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health