Healthcare Provider Details

I. General information

NPI: 1134090319
Provider Name (Legal Business Name): TERRY PATRICE STEPHENS-TERRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 DAYTON ST & REMOTE LOCATIONS, MILITARY BASES
BATON ROUGE LA
70805-4022
US

IV. Provider business mailing address

3005 DAYTON ST
BATON ROUGE LA
70805-4022
US

V. Phone/Fax

Practice location:
  • Phone: 225-207-7473
  • Fax:
Mailing address:
  • Phone: 225-207-7473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number318362
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number320837880125
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberCN0014256052
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateLA
# 5
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberPA-NA
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License NumberPA-NA
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateOK
# 8
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateLA
# 9
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: