Provider Demographics
NPI:1568222990
Name:TERRY, STEPHEN MATTHEW I (FDNP)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MATTHEW
Last Name:TERRY
Suffix:I
Gender:M
Credentials:FDNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14008 FONTANA ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66224-3645
Mailing Address - Country:US
Mailing Address - Phone:913-832-7150
Mailing Address - Fax:
Practice Address - Street 1:14008 FONTANA ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66224-3645
Practice Address - Country:US
Practice Address - Phone:913-832-7150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach