Provider Demographics
NPI:1932810553
Name:TERRY, LAUREN LAVERNE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:LAVERNE
Last Name:TERRY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 BOULEVARD SOUTH SW STE 104
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-2175
Mailing Address - Country:US
Mailing Address - Phone:888-499-3506
Mailing Address - Fax:
Practice Address - Street 1:600 BOULEVARD SOUTH SW
Practice Address - Street 2:SUITE 104 #1069
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802
Practice Address - Country:US
Practice Address - Phone:888-499-3506
Practice Address - Fax:256-208-9899
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2023-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY432520363LA2100X, 363LA2200X
AL1-135432363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care