Provider Demographics
NPI:1093018541
Name:KING, TERRA (CPNP)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 S WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-3840
Mailing Address - Country:US
Mailing Address - Phone:931-526-6173
Mailing Address - Fax:931-526-5084
Practice Address - Street 1:758 S WILLOW AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3840
Practice Address - Country:US
Practice Address - Phone:931-526-6173
Practice Address - Fax:931-526-5084
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11247363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN11247OtherSTATE LICENSE
TN11247OtherSTATE LICENSE