Provider Demographics
NPI:1225323181
Name:CARGILE, TERRY ELLIS
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:ELLIS
Last Name:CARGILE
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 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-347-4662
Mailing Address - Fax:417-347-9172
Practice Address - Street 1:1020 MCINTOSH CIR STE 200
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3697
Practice Address - Country:US
Practice Address - Phone:417-781-7110
Practice Address - Fax:417-781-8117
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020014037363L00000X
FLARNP 9359842363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner