Provider Demographics
NPI:1003370404
Name:YINGLING, TERRI R (LSA)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:R
Last Name:YINGLING
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93150
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1150
Mailing Address - Country:US
Mailing Address - Phone:817-454-2584
Mailing Address - Fax:214-764-0880
Practice Address - Street 1:4050 MCEWEN RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5421
Practice Address - Country:US
Practice Address - Phone:817-454-2584
Practice Address - Fax:972-986-5304
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00847246ZC0007X
TX187816246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant