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General NPI Number Information
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NPI Number | 1316787161
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Entity Type | Individual
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Provider Name | MS. ALI MAY TERRY
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Gender | Female
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 321 S AVENUE C
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City | PORTALES
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State | NM
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Zip | 88130-6253
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Country | US
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Telephone | 575-760-0754
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Fax |
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Provider Business Mailing Address
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Address Line | 44 S ROOSEVELT ROAD AD
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City | PORTALES
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State | NM
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Zip | 88130-9548
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Country | US
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Telephone | 575-760-0754
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Fax | 844-638-0665
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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