Provider Demographics
NPI:1952851289
Name:SHERIFF, TERA
Entity Type:Individual
Prefix:
First Name:TERA
Middle Name:
Last Name:SHERIFF
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 1:4154 PLAZA ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-4720
Mailing Address - Country:US
Mailing Address - Phone:601-850-8930
Mailing Address - Fax:
Practice Address - Street 1:1900 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2234
Practice Address - Country:US
Practice Address - Phone:601-850-8930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS814086801OtherEIN