Provider Demographics
NPI:1760870554
Name:NUNLEY, TERRY LEE (MSN)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LEE
Last Name:NUNLEY
Suffix:
Gender:M
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 791
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-0791
Mailing Address - Country:US
Mailing Address - Phone:888-654-8099
Mailing Address - Fax:888-873-9399
Practice Address - Street 1:1125 WEST ST STE 200
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4279
Practice Address - Country:US
Practice Address - Phone:888-654-8099
Practice Address - Fax:888-873-9399
Is Sole Proprietor?:No
Enumeration Date:2014-12-31
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172252363LF0000X
AL1-167678363LF0000X
MDAC001587363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-167678OtherLICENSE
MDAC001587OtherLICENSE
MD945001701Medicaid