Healthcare Provider Details

I. General information

NPI: 1316566359
Provider Name (Legal Business Name): TERRY MUSGROVE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 E PARKS HIGHWAY
WASILLA AK
99654-8298
US

IV. Provider business mailing address

1365 E PARKS HIGHWAY
WASILLA AK
99654-8298
US

V. Phone/Fax

Practice location:
  • Phone: 907-357-6445
  • Fax: 907-376-6402
Mailing address:
  • Phone: 907-357-6445
  • Fax: 907-376-6402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: