MEDICARE: TERI LEE GLASCOCK PNP-LPA

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
1	363LP0200X	Pediatric Nurse Practitioner	554499	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225118722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERI LEE GLASCOCK PNP-LPA

Provider Business Mailing Address
First Line	:	1307 MLK BLVD
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79403-5329
Country	:	US
Telephone Number	:	806-749-3800
Fax Number	:	806-749-3803

Provider Business Practice Location Address
First Line	:	1307 MLK BLVD
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79403-5329
Country	:	US
Telephone Number	:	806-749-3800
Fax Number	:	806-749-3802

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	10/14/2025

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