Provider Demographics
NPI:1467075440
Name:TEAGUE, LYDIA A (AGNP-C)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:A
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-8230
Mailing Address - Country:US
Mailing Address - Phone:828-645-7974
Mailing Address - Fax:828-645-9798
Practice Address - Street 1:104 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-8230
Practice Address - Country:US
Practice Address - Phone:828-645-7974
Practice Address - Fax:828-645-9798
Is Sole Proprietor?:No
Enumeration Date:2020-05-25
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013276363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care