Provider Demographics
NPI:1952433328
Name:NELSON, TERRA G (NP)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:G
Last Name:NELSON
Suffix:
Gender:F
Credentials:NP
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 656
Mailing Address - Street 2:
Mailing Address - City:SUMITON
Mailing Address - State:AL
Mailing Address - Zip Code:35148-0656
Mailing Address - Country:US
Mailing Address - Phone:205-648-2660
Mailing Address - Fax:205-648-2886
Practice Address - Street 1:1190 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SUMITON
Practice Address - State:AL
Practice Address - Zip Code:35148
Practice Address - Country:US
Practice Address - Phone:205-648-2660
Practice Address - Fax:205-648-2886
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF0806191363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner