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General NPI Number Information
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NPI Number | 1851759534
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Entity Type | Organization
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Legal Business Name | TERRI SURESH ACNP PLLC
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Dates
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Enumeration Date | 02/09/2016
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Last Update Date | 02/09/2016
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Provider Practice Location Address
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Address Line | 620 N KIMBALL AVE STE 100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6855
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Country | US
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Telephone | 817-328-8376
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Fax | 817-328-8379
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Provider Business Mailing Address
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Address Line | 620 N KIMBALL AVE STE 100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6855
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Country | US
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Telephone | 817-328-8376
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Fax | 817-328-8379
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Authorized Official
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Title or Position | OWNER
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Name | TERRI JENAI SURESH
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Credential | APRN
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Telephone | 817-328-8376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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