Provider Demographics
NPI:1750322913
Name:LEA, TERRY MICHAEL (ANP-BC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:MICHAEL
Last Name:LEA
Suffix:
Gender:M
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30926 SIFTON DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-2236
Mailing Address - Country:US
Mailing Address - Phone:832-493-2276
Mailing Address - Fax:
Practice Address - Street 1:7887 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2013
Practice Address - Country:US
Practice Address - Phone:832-493-2276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP110995363LF0000X
TX601407363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNP7269OtherBCBS
TX613737Medicare PIN
TXNP7269OtherBCBS