Provider Demographics
NPI:1346296910
Name:MULLIGAN, TERRY LEE (PA)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LEE
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:LEE
Other - Last Name:MULLIGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:475 ROSE HILL RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8543
Mailing Address - Country:US
Mailing Address - Phone:828-638-8142
Mailing Address - Fax:828-771-2634
Practice Address - Street 1:100 FAR HORIZONS LN
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2046
Practice Address - Country:US
Practice Address - Phone:828-771-2219
Practice Address - Fax:828-771-2634
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1013174363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS59093Medicare UPIN