Provider Demographics
NPI:1447966981
Name:ARMSTRONG, TELISA D
Entity type:Individual
Prefix:
First Name:TELISA
Middle Name:D
Last Name:ARMSTRONG
Suffix:
Gender:F
Credentials:
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 1995
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:UT
Mailing Address - Zip Code:84713-1995
Mailing Address - Country:US
Mailing Address - Phone:575-461-8607
Mailing Address - Fax:270-203-0587
Practice Address - Street 1:50 S 100 W
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:UT
Practice Address - Zip Code:84713-8471
Practice Address - Country:US
Practice Address - Phone:575-461-8607
Practice Address - Fax:270-203-0587
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT15840608Medicaid