Provider Demographics
NPI:1639127780
Name:COYLE, TERRY L (DC, FNP)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:COYLE
Suffix:
Gender:M
Credentials:DC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 S HIGHWAY 95
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-9374
Mailing Address - Country:US
Mailing Address - Phone:928-768-2811
Mailing Address - Fax:928-768-9787
Practice Address - Street 1:5130 S HIGHWAY 95
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-9374
Practice Address - Country:US
Practice Address - Phone:928-768-2811
Practice Address - Fax:928-768-9787
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5296363LF0000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ162195Medicare UPIN
ILU81307Medicare UPIN