Provider Demographics
NPI:1952345399
Name:SUMPTER, TERRY ALVIN (CRNA)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:ALVIN
Last Name:SUMPTER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 NORTH MAIN
Mailing Address - Street 2:
Mailing Address - City:LOVINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:88260-2813
Mailing Address - Country:US
Mailing Address - Phone:575-396-6611
Mailing Address - Fax:575-396-0318
Practice Address - Street 1:1600 NORTH MAIN
Practice Address - Street 2:
Practice Address - City:LOVINGTON
Practice Address - State:NM
Practice Address - Zip Code:88260-2813
Practice Address - Country:US
Practice Address - Phone:575-396-6611
Practice Address - Fax:575-396-0318
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC00514367500000X
NMCRNA00964367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y838OtherBLUE CROSS AR PROVIDER #
AR5Y838OtherBLUE CROSS AR PROVIDER #