Provider Demographics
NPI:1285010611
Name:KLOTH, TERRA LYNN (CRNA)
Entity Type:Individual
Prefix:
First Name:TERRA LYNN
Middle Name:
Last Name:KLOTH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6451 COME ABOUT WAY
Mailing Address - Street 2:
Mailing Address - City:AWENDAW
Mailing Address - State:SC
Mailing Address - Zip Code:29429-6022
Mailing Address - Country:US
Mailing Address - Phone:608-217-5503
Mailing Address - Fax:
Practice Address - Street 1:6451 COME ABOUT WAY
Practice Address - Street 2:
Practice Address - City:AWENDAW
Practice Address - State:SC
Practice Address - Zip Code:29429-6022
Practice Address - Country:US
Practice Address - Phone:608-217-5503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC215418367500000X
SC19776367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered