Provider Demographics
NPI:1508016908
Name:TERRY, JEVITA DENISE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JEVITA
Middle Name:DENISE
Last Name:TERRY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JEVITA
Other - Middle Name:BOSTIC
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2723
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27802-2723
Mailing Address - Country:US
Mailing Address - Phone:252-210-9856
Mailing Address - Fax:252-822-5067
Practice Address - Street 1:300 N GRACE ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-5345
Practice Address - Country:US
Practice Address - Phone:252-210-9856
Practice Address - Fax:252-822-5067
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC120969363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1982905832OtherGROUP
NC1508016908Medicaid