Provider Demographics
NPI:1689465239
Name:TERRY, LUKE JOHNATHAN (VOLUNTEER)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:JOHNATHAN
Last Name:TERRY
Suffix:
Gender:M
Credentials:VOLUNTEER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 S PARK LN
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-5720
Mailing Address - Country:US
Mailing Address - Phone:321-474-7195
Mailing Address - Fax:
Practice Address - Street 1:404 S PARK LN
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-5720
Practice Address - Country:US
Practice Address - Phone:321-474-7195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist