Provider Demographics
NPI:1841764735
Name:TERRY, SAMANTHA TAKEYLA (LVN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:TAKEYLA
Last Name:TERRY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27615 E BENDERS LANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-2804
Mailing Address - Country:US
Mailing Address - Phone:832-696-3501
Mailing Address - Fax:
Practice Address - Street 1:27615 E BENDERS LANDING BLVD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-2804
Practice Address - Country:US
Practice Address - Phone:832-696-3501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX345387164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse