Provider Demographics
NPI:1740671718
Name:TERRY, DESTINY
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:
Last Name:TERRY
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 1:713 BLUE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-4606
Mailing Address - Country:US
Mailing Address - Phone:580-209-2821
Mailing Address - Fax:
Practice Address - Street 1:6501 BROADWAY EXT
Practice Address - Street 2:SUITE 180
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-8239
Practice Address - Country:US
Practice Address - Phone:405-607-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator