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NPI Code Detail

MEDICARE: DONNA TERRY PA-C

MEDICARE: DONNA TERRY PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantA10282LA

General Provider Information

NPI Number : 1104823947
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONNA TERRY PA-C
Provider Business Mailing Address
First Line : PO BOX 5687
Second Line :
City : SHREVEPORT
State : LA
Zip : 71135-5687
Country : US
Telephone Number : 318-797-6661
Fax Number : 318-795-8512
Provider Business Practice Location Address
First Line : 8383 MILLICENT WAY
Second Line :
City : SHREVEPORT
State : LA
Zip : 71115-5207
Country : US
Telephone Number : 318-797-6661
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 07/08/2007

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Directions to “ DONNA TERRY PA-C” Practice Location

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