MEDICARE: TERRI L STITLE NP

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	363LF0000X	Family Nurse Practitioner	460550	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457319162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRI L STITLE NP

Provider Business Mailing Address
First Line	:	317 N FM ROAD 1187
Second Line	:
City	:	ALEDO
State	:	TX
Zip	:	76008-4200
Country	:	US
Telephone Number	:	817-441-7181
Fax Number	:	817-441-7893

Provider Business Practice Location Address
First Line	:	317 N FM ROAD 1187
Second Line	:
City	:	ALEDO
State	:	TX
Zip	:	76008-4200
Country	:	US
Telephone Number	:	817-441-7181
Fax Number	:	817-441-7893

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

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	01/20/2011

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Directions to “ TERRI L STITLE NP” Practice Location

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