Provider Demographics
NPI:1598715344
Name:MUELLER, TERRI L (PA-C)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:MUELLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:
Other - Last Name:TIEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:353 FAIRMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7375
Mailing Address - Country:US
Mailing Address - Phone:605-755-8107
Mailing Address - Fax:
Practice Address - Street 1:353 FAIRMONT BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7375
Practice Address - Country:US
Practice Address - Phone:605-755-8222
Practice Address - Fax:605-719-4203
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0464363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDP00365336OtherRR MEDICARE
SD4994217OtherWELLMARK
SD6822893Medicaid
SD9241809OtherDAKOTACARE
P27844Medicare UPIN
SD9241809OtherDAKOTACARE