Healthcare Provider Details

I. General information

NPI: 1861971590
Provider Name (Legal Business Name): STEPHANIE L TERRILL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE L MOOSMAN PA-C

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 S GILBERT RD STE 101
GILBERT AZ
85296-2261
US

IV. Provider business mailing address

2563 S VAL VISTA DR STE 101
GILBERT AZ
85295-6231
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-8282
  • Fax: 844-470-2777
Mailing address:
  • Phone: 480-573-0130
  • Fax: 480-573-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number7214
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7214
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: