Healthcare Provider Details

I. General information

NPI: 1215911847
Provider Name (Legal Business Name): TERRI L DEGEEST CNM, OB GYN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERRI L WYNN-HIPPS CNM

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WOMACK ARMY MEDICAL CTR 2817 REILLY ROAD
FORT BRAGG NC
28310-0001
US

IV. Provider business mailing address

7104 CALAMAR DR
FAYETTEVILLE NC
28314-5215
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-7994
  • Fax:
Mailing address:
  • Phone: 910-867-1373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCNM- 359
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberF360483-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: