Provider Demographics
NPI:1760824460
Name:ROBERTS, TERRA (RN)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 WAYLAND DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762
Mailing Address - Country:US
Mailing Address - Phone:432-550-0268
Mailing Address - Fax:432-550-0193
Practice Address - Street 1:2525 N GRANDVIEW AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-1600
Practice Address - Country:US
Practice Address - Phone:432-550-4700
Practice Address - Fax:432-550-4715
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX756328163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health