Provider Demographics
NPI:1710982285
Name:DEVLIN, TERRI (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:
Last Name:DEVLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1357 W COLLIN RAYE DR
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-2946
Mailing Address - Country:US
Mailing Address - Phone:870-642-4364
Mailing Address - Fax:
Practice Address - Street 1:1357 W COLLIN RAYE DR
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-2946
Practice Address - Country:US
Practice Address - Phone:870-642-4364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2169208000000X
ARE-2169208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100248960AMedicaid
AR186480000OtherQUALCHOICE
AR137581001Medicaid
AR5L261OtherBCBS
OK100025500AMedicaid
OK100025500AMedicaid
AR5L261OtherHEALTH ADVANTAGE
OK100248960AMedicaid