Provider Demographics
NPI:1942823018
Name:SHANK, TERRANCE HUNTAR (PA-C)
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:HUNTAR
Last Name:SHANK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 FARROW HILL RD
Mailing Address - Street 2:
Mailing Address - City:DAVISVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26142-8878
Mailing Address - Country:US
Mailing Address - Phone:304-588-9684
Mailing Address - Fax:
Practice Address - Street 1:800 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5376
Practice Address - Country:US
Practice Address - Phone:304-588-9684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2375363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant