Provider Demographics
NPI:1275023848
Name:WYRICK, TERRI MELISSA
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:MELISSA
Last Name:WYRICK
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 1:432 VZ CR 1523
Mailing Address - Street 2:
Mailing Address - City:GRAND SALINE
Mailing Address - State:TX
Mailing Address - Zip Code:75140
Mailing Address - Country:US
Mailing Address - Phone:903-368-1373
Mailing Address - Fax:
Practice Address - Street 1:432 VZ CR 1523
Practice Address - Street 2:
Practice Address - City:GRAND SALINE
Practice Address - State:TX
Practice Address - Zip Code:75140
Practice Address - Country:US
Practice Address - Phone:903-368-1373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX309460164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse