Provider Demographics
NPI:1588674527
Name:TURPEN, TERRENCE C (PA-C)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:C
Last Name:TURPEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 258
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-0258
Mailing Address - Country:US
Mailing Address - Phone:209-223-7784
Mailing Address - Fax:209-223-7783
Practice Address - Street 1:601 COURT ST STE 210
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2163
Practice Address - Country:US
Practice Address - Phone:209-223-7784
Practice Address - Fax:209-223-7783
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10380363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA10380Medicaid
CAP11156Medicare UPIN
CAPA10380Medicaid