Provider Demographics
NPI:1659653558
Name:TERRY, MEGAN RENEE (ANP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:RENEE
Last Name:TERRY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 BURNETT DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2908
Mailing Address - Country:US
Mailing Address - Phone:870-425-9120
Mailing Address - Fax:870-424-7666
Practice Address - Street 1:901 BURNETT DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2908
Practice Address - Country:US
Practice Address - Phone:870-425-9120
Practice Address - Fax:870-424-7666
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03606363LX0001X
ARF0816278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology