Provider Demographics
NPI:1225118722
Name:GLASCOCK, TERI LEE (PNP-LPA)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:LEE
Last Name:GLASCOCK
Suffix:
Gender:F
Credentials:PNP-LPA
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 5576
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-5576
Mailing Address - Country:US
Mailing Address - Phone:432-697-4747
Mailing Address - Fax:432-699-3813
Practice Address - Street 1:2500 DELANO AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6357
Practice Address - Country:US
Practice Address - Phone:432-697-4747
Practice Address - Fax:432-699-3813
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX554499363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP41906Medicare ID - Type Unspecified