Provider Demographics
NPI:1356841167
Name:TEDDER, TERRI LYNN (LVN)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:LYNN
Last Name:TEDDER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 32ND ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3412
Mailing Address - Country:US
Mailing Address - Phone:806-782-5198
Mailing Address - Fax:
Practice Address - Street 1:623 S CROSBY ST
Practice Address - Street 2:
Practice Address - City:CROSBYTON
Practice Address - State:TX
Practice Address - Zip Code:79322-3301
Practice Address - Country:US
Practice Address - Phone:806-777-8812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX335108164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX02148414OtherDL