Provider Demographics
NPI:1740283357
Name:TERRY, DEBORAH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:TERRY
Suffix:
Gender:F
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:PO BOX 540
Mailing Address - Street 2:
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-0540
Mailing Address - Country:US
Mailing Address - Phone:423-784-8492
Mailing Address - Fax:423-784-8358
Practice Address - Street 1:5663 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:CLAIRFIELD
Practice Address - State:TN
Practice Address - Zip Code:37715-3632
Practice Address - Country:US
Practice Address - Phone:423-784-6135
Practice Address - Fax:423-784-8615
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA 180363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95620076Medicaid
TN1511908Medicaid
TN180OtherSTATE LICENSE
TNMT0601220OtherDEA