Healthcare Provider Details

I. General information

NPI: 1558141796
Provider Name (Legal Business Name): TERYN LIES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3662 E ZACHARY DR
PHOENIX AZ
85050-8383
US

IV. Provider business mailing address

3662 E ZACHARY DR
PHOENIX AZ
85050-8383
US

V. Phone/Fax

Practice location:
  • Phone: 602-616-4584
  • Fax:
Mailing address:
  • Phone: 602-616-4584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number301361
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: