MEDICARE: TERRY PATRICE STEPHENS-TERRELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1002X	Independent Duty Corpsman	PA-NA	CA
2	171W00000X	Contractor	CN0014256052	GA
3	171400000X	Health & Wellness Coach		AL
4	174H00000X	Health Educator		LA
5	183700000X	Pharmacy Technician		LA
6	251E00000X	Home Health Agency	318362	LA
7	251J00000X	Nursing Care Agency	320837880125	OK
8	253Z00000X	In Home Supportive Care Agency		OK
9	171000000X	Military Health Care Provider	PA-NA	MO

General Provider Information

NPI Number	:	1134090319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY PATRICE STEPHENS-TERRELL

Provider Business Mailing Address
First Line	:	3005 DAYTON ST
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70805-4022
Country	:	US
Telephone Number	:	225-207-7473
Fax Number	:

Provider Business Practice Location Address
First Line	:	3005 DAYTON ST & REMOTE LOCATIONS, MILITARY BASES
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70805-4022
Country	:	US
Telephone Number	:	225-207-7473
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2025
Last Update Date	:	09/12/2025

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