Provider Demographics
NPI:1225339187
Name:GYDE, TERRY ANN (CPM,LM)
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:ANN
Last Name:GYDE
Suffix:
Gender:F
Credentials:CPM,LM
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:ANN
Other - Last Name:GYDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPM, LM
Mailing Address - Street 1:612 S ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-4114
Mailing Address - Country:US
Mailing Address - Phone:817-727-5529
Mailing Address - Fax:817-887-1537
Practice Address - Street 1:612 S ROGERS ST
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165
Practice Address - Country:US
Practice Address - Phone:817-727-5529
Practice Address - Fax:817-887-1537
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2018-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99138176B00000X
174H00000X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX99138OtherSTATE LICENSED