Provider Demographics
NPI:1558649905
Name:KLICK, TERRI LYNN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:LYNN
Last Name:KLICK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 LELA ST
Mailing Address - Street 2:
Mailing Address - City:MANGHAM
Mailing Address - State:LA
Mailing Address - Zip Code:71259-5063
Mailing Address - Country:US
Mailing Address - Phone:318-248-4100
Mailing Address - Fax:318-248-4103
Practice Address - Street 1:107 LELA ST
Practice Address - Street 2:
Practice Address - City:MANGHAM
Practice Address - State:LA
Practice Address - Zip Code:71259-5063
Practice Address - Country:US
Practice Address - Phone:318-248-4100
Practice Address - Fax:318-248-4103
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06543363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily