Provider Demographics
NPI:1922729599
Name:TERRY, SHALENE (PMHNP)
Entity Type:Individual
Prefix:
First Name:SHALENE
Middle Name:
Last Name:TERRY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:782 S RIVER RD # 175
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-5716
Mailing Address - Country:US
Mailing Address - Phone:435-619-5493
Mailing Address - Fax:
Practice Address - Street 1:1664 S DIXIE DR STE E102
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7329
Practice Address - Country:US
Practice Address - Phone:435-703-9647
Practice Address - Fax:435-703-6003
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9674350-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health