Provider Demographics
NPI:1013635945
Name:GATES, TERRAN ELIZABETH (CPO, MSPO)
Entity Type:Individual
Prefix:
First Name:TERRAN
Middle Name:ELIZABETH
Last Name:GATES
Suffix:
Gender:F
Credentials:CPO, MSPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11766 VALLEYVIEW LN
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-9330
Mailing Address - Country:US
Mailing Address - Phone:870-307-2174
Mailing Address - Fax:
Practice Address - Street 1:1325 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2212
Practice Address - Country:US
Practice Address - Phone:479-418-2297
Practice Address - Fax:479-227-5439
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROPP00298222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE