Provider Demographics
NPI:1164900734
Name:HENRY, TERRY HERRING
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:HERRING
Last Name:HENRY
Suffix:
Gender:F
Credentials:
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 1005
Mailing Address - Street 2:
Mailing Address - City:SALEMBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28385-1005
Mailing Address - Country:US
Mailing Address - Phone:910-385-5647
Mailing Address - Fax:
Practice Address - Street 1:504 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3417
Practice Address - Country:US
Practice Address - Phone:910-221-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-05
Last Update Date:2018-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner