Provider Demographics
NPI:1760086433
Name:ROYSTON, TERA Y (CM/BA)
Entity Type:Individual
Prefix:
First Name:TERA
Middle Name:Y
Last Name:ROYSTON
Suffix:
Gender:F
Credentials:CM/BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 OFFUTT SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:WV
Mailing Address - Zip Code:26704-7278
Mailing Address - Country:US
Mailing Address - Phone:540-336-2026
Mailing Address - Fax:
Practice Address - Street 1:570 OFFUTT SCHOOL RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:WV
Practice Address - Zip Code:26704-7278
Practice Address - Country:US
Practice Address - Phone:540-336-2026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator