Provider Demographics
NPI:1376134122
Name:TERRY, JAWANDA LAFAYE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:JAWANDA
Middle Name:LAFAYE
Last Name:TERRY
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 1:5657 SEAWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-5013
Mailing Address - Country:US
Mailing Address - Phone:870-278-4770
Mailing Address - Fax:
Practice Address - Street 1:5657 SEAWOOD DR
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-5013
Practice Address - Country:US
Practice Address - Phone:870-278-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health