Healthcare Provider Details

I. General information

NPI: 1659289429
Provider Name (Legal Business Name): RYAN MICHAEL TERRY AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3511 W MARKET ST STE 100
GREENSBORO NC
27403-4444
US

IV. Provider business mailing address

3100 RUIDOSO AVE APT 208
GREENSBORO NC
27410-9959
US

V. Phone/Fax

Practice location:
  • Phone: 336-522-8999
  • Fax:
Mailing address:
  • Phone: 413-464-4933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5025362
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: