Provider Demographics
NPI:1457319162
Name:STITLE, TERRI L (NP)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:STITLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:LEA
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:317 N FM ROAD 1187
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-4200
Mailing Address - Country:US
Mailing Address - Phone:817-441-7181
Mailing Address - Fax:817-441-7893
Practice Address - Street 1:317 N FM ROAD 1187
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-4200
Practice Address - Country:US
Practice Address - Phone:817-441-7181
Practice Address - Fax:817-441-7893
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX460550363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156164903Medicaid
TX156164902Medicaid
TX156164904Medicaid
TXP80946Medicare UPIN
TX8J0011Medicare ID - Type Unspecified
TX8J0012Medicare ID - Type Unspecified