=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437592748
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERRI L SPECK NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2013
-----------------------------------------------------
Last Update Date | 04/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1571 SW WILSHIRE BLVD STE 500
-----------------------------------------------------
City | BURLESON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76028-8717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-295-1121
-----------------------------------------------------
Fax | 817-295-8170
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1571 SW WILSHIRE BLVD STE 500
-----------------------------------------------------
City | BURLESON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76028-8717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-295-1121
-----------------------------------------------------
Fax | 817-295-8170
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SF0001X
-----------------------------------------------------
Taxonomy Name | Family Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | AP123360
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------