Provider Demographics
NPI:1043090830
Name:MARTIN, TERAN ASHLEY (CLC)
Entity Type:Individual
Prefix:
First Name:TERAN
Middle Name:ASHLEY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:BOKCHITO
Mailing Address - State:OK
Mailing Address - Zip Code:74726
Mailing Address - Country:US
Mailing Address - Phone:719-650-9406
Mailing Address - Fax:
Practice Address - Street 1:179 DAVIS RD
Practice Address - Street 2:
Practice Address - City:BOKCHITO
Practice Address - State:OK
Practice Address - Zip Code:74726
Practice Address - Country:US
Practice Address - Phone:719-650-9406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPP-346306174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN