Provider Demographics
NPI:1871184895
Name:CORLEY, TERRA
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:
Last Name:CORLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 QUAIL SPRINGS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-2699
Mailing Address - Country:US
Mailing Address - Phone:405-241-3791
Mailing Address - Fax:405-241-0998
Practice Address - Street 1:3200 QUAIL SPRINGS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-2699
Practice Address - Country:US
Practice Address - Phone:405-241-3791
Practice Address - Fax:405-241-0998
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2009702086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery