1851759534 NPI number — TERRI SURESH ACNP PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851759534 NPI number — TERRI SURESH ACNP PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TERRI SURESH ACNP PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851759534
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 N KIMBALL AVE
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
SOUTHLAKE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76092-6855
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-328-8376
Provider Business Mailing Address Fax Number:
817-328-8379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 N KIMBALL AVE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
SOUTHLAKE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76092-6855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-328-8376
Provider Business Practice Location Address Fax Number:
817-328-8379
Provider Enumeration Date:
02/09/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SURESH
Authorized Official First Name:
TERRI
Authorized Official Middle Name:
JENAI
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
817-328-8376

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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