Provider Demographics
NPI:1689363814
Name:REDDICK, TERRIS T
Entity Type:Individual
Prefix:
First Name:TERRIS
Middle Name:T
Last Name:REDDICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 EVANS ST STE 208
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5303
Mailing Address - Country:US
Mailing Address - Phone:919-623-1534
Mailing Address - Fax:
Practice Address - Street 1:1530 EVANS ST STE 208
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5303
Practice Address - Country:US
Practice Address - Phone:919-623-1534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide