Provider Demographics
NPI:1831816545
Name:TERRY, JACQUELINE MONIQUE (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:MONIQUE
Last Name:TERRY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 S LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-5812
Mailing Address - Country:US
Mailing Address - Phone:423-539-0781
Mailing Address - Fax:
Practice Address - Street 1:604 S LAKE DR
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-5812
Practice Address - Country:US
Practice Address - Phone:423-539-0781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32710363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health